Functional and anatomical outcomes of various perioperative treatment strategies for diabetic macular edema after cataract phacoemulsification

Selecting the optimal perioperative treatment strategy for diabetic macular edema (DME) in patients undergoing cataract phacoemulsification remains an important clinical challenge. The effects of different approaches on changes in morphological OCT biomarkers remain insufficiently studied. Objective. The study aimed to compare the functional and anatomical outcomes of three perioperative strategies for DME treatment after cataract phacoemulsification. Material and methods. This retrospective cohort study included 102 patients (102 eyes) with type 2 diabetes mellitus, DME, and cataract. In group 1 (n=42), patients received preoperative anti-VEGF therapy followed by treatment according to the Treat-and-Extend regimen, group 2 (n=29) in addition to the same anti-VEGF regimen underwent intraoperative dexamethasone implantation, and group 3 (n=31) first underwent intraoperative dexamethasone implantation and then received anti-VEGF therapy. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), central choroidal thickness (CCT), fluid OCT biomarkers, hyperreflective foci, and the inter-injection interval were assessed. Results. BCVA improved significantly in all groups by month 12 of follow-up (from 0.22±0.12 to 0.64±0.17; p<0.001). The combined strategy provided the earliest reduction in CRT and CCT, rapid resolution of intraretinal and subretinal fluid, a decrease in the number of hyperreflective foci, and prolongation of the inter-injection interval. With the DEX-first strategy, after a pronounced early effect, by month 6 DME had reactivated with loss of anatomical response. Conclusions. Despite comparable functional outcomes at 12 months, the perioperative strategies differed substantially in the speed of achieving and maintaining anatomical response. The combined strategy provided the most favorable trajectory of morphological response and the most effective control of the inflammatory and exudative activity of DME in the early postoperative period.