Incidence And Progression Of Diabetic Retinopathy After Cataract Surgery: A 10-Year Hospital-Based Cohort Study

To evaluate the incidence and progression of diabetic retinopathy (DR) after cataract surgery in patients with diabetes and to identify systemic and ocular risk factors associated with postoperative retinal outcomes.

Department of Ophthalmology, Hualien Tzu Chi Hospital, a tertiary referral center in Taiwan.

This retrospective cohort study included patients with type 2 diabetes who underwent phacoemulsification between 2011 and 2024. A fellow-eye design compared surgical eyes with contralateral nonsurgical eyes (n=1,273). In addition, a matched cohort analysis compared 535 surgical eyes with 1,070 age- and sex-matched nonsurgical diabetic controls. DR severity was graded using the International Clinical Diabetic Retinopathy (ICDR) scale. DR progression was defined as at least one-step worsening or development of proliferative complications. Multivariable logistic regression identified risk factors for DR progression at 6 months and 1 year.

In the fellow-eye analysis, DR progression was more frequent in surgical eyes than in nonsurgical eyes (6.0% vs 1.8% at 1 year, p<0.001). Among eyes without baseline DR, the incidence of DR was also higher in surgical eyes (4.4% vs 1.5%). In the matched cohort analysis, cataract surgery remained associated with increased DR progression (adjusted OR 2.73, 95% CI 1.45–5.15). Higher preoperative HbA1c levels were significantly associated with DR progression.

Cataract surgery in patients with diabetes is associated with an increased risk of both incident DR and DR progression within one year. Poor glycemic control is the most consistent modifiable predictor of postoperative retinal deterioration. Optimization of systemic metabolic status and close postoperative retinal monitoring are essential in diabetic patients undergoing cataract surgery.