When is the ideal time for cataract surgery in a patient with visually significant cataract just beginning anti-VEGF treatment for DME?

There are several important factors in the optimal timing of cataract extraction in patients receiving anti-vascular endothelial growth factor intravitreal injections (IVI) for diabetic macular edema (DME), including the severity of diabetic retinopathy, amount of macular edema, and extent of cataract.

Pre-existing DME is a risk factor for post-operative macular edema, and should be optimized prior to cataract surgery. In my practice, I generally recommend two to three monthly IVIs prior to cataract extraction, with a plan to do another injection around one month postoperatively. If a patient has a very advanced cataract, I would still try to do at least one IVI a few weeks preoperatively, with a plan to continue postoperatively. I counsel ...