Cataract Surgery may increase risk of worsening of Diabetic Retinopathy, finds study

A new study published in the journal of Ophthalmology found cataract surgery to worsen diabetic retinopathy in adults with type 2 diabetes. Individuals with diabetes are more prone to complications following cataract surgery. While surgery should not be avoided, regular monitoring and follow-up care are crucial to managing potential complications.

Diabetic individuals can have great eyesight following cataract surgery, provided they have meticulous preoperative planning, phacoemulsification, and attentive postoperative management. Thus, this study evaluated the impact of contemporary cataract surgery on the development of proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes (T2D) as opposed to non-proliferative diabetic retinopathy (NPDR).

A review of the TriNetX United States Collaborative research network aggregated health data from June 2004 to June 2024. This study looked at patients with T2D and NPDR who were at least 18 years old and had either regular cataract surgery or no cataract surgery. The propensity score matching (PSM) was utilized to balance baseline demographic and clinical factors after researchers analyzed data from US healthcare institutions using the TriNetX integrated analytics platform.

Prior to cataract surgery, individuals with at least 5 years of T2D were evaluated using a sensitivity analysis and hazard ratios (HR) with 95% confidence intervals (95% CI). Main outcomes were patients who had cataract surgery had a higher chance of developing tractional retinal detachment (TRD), combined tractional and rhegmatogenous retinal detachment (CTRD), vitreous hemorrhage (VH), and a composite result at one year when compared to those who did not.

For the right eye analysis, there were 7178 individuals in the study (n=3589) and control (n=3589) cohorts after PSM. Also, operated eyes had higher 1-year chances of PDR without complications, VH, and the composite outcome. A total of 7232 participants in the study (n = 3616) and control (n = 3616) cohorts after PSM were included in the left eye analysis. The operated eyes had higher 1-year probabilities of PDR without difficulties, VH, and the composite outcome.

Nearly, 4976 patients in the trial (n=2488) and control (n=2488) cohorts post-PSM were included in the sensitivity analysis of those with at least 5 years of T2D. Also, operated eyes showed higher 1-year risks of PDR without difficulties, VH, and the composite outcome. In every analysis, there was no discernible difference between the risk for TRD and CTRD. Overall, within a year following modern cataract surgery, there was a correlation between the transition from T2D NPDR to PDR.

Reference:

Loya, A., Hussain, Z. S., Muayad, J., Chauhan, M. Z., Soliman, M. K., & Sallam, A. B. (2025). Risk of progression of non-proliferative to proliferative diabetic retinopathy following cataract surgery. Ophthalmology. https://doi.org/10.1016/j.ophtha.2025.02.006