Study: Cataract surgery increases diabetic retinopathy progression

Editor's Note

Cataract surgery raises the risk of worsening diabetic retinopathy in adults with type 2 diabetes, according to a February 24 article in MedPage Today.

The article focused on a a retrospective analysis published in the journal Ophthalmology. The study involved a large dataset from the TriNetX research network, covering June 2004 to June 2024, when phacoemulsification was the primary method of cataract surgery. Researchers compared outcomes between adults with type 2 diabetes and non-proliferative diabetic retinopathy who had cataract surgery and those who did not. After propensity score matching, the analysis included 7,178 patients for the right eye and 7,232 for the left eye, with an average age of about 67 years.

As detailed in the article, cataract surgery patients faced increased 1-year risks of proliferative diabetic retinopathy (PDR) without complications, vitreous hemorrhage, and a composite outcome that included tractional retinal detachment. In patients with type 2 diabetes for at least 5 years, cataract surgery was linked to even higher risks. No significant difference was observed in the risk for tractional retinal detachment across all analyses.

The article quotes lead study author Ahmed Sallam, MD, PhD, of the University of Arkansas for Medical Sciences, emphasizing the importance of close, postoperative monitoring for diabetic retinopathy progression to increase likelihood of earlier detection and better outcomes. He also stressed vigilance rather than avoidance of surgery, noting that treatment significantly improves vision and quality of life.  

The article also quotes co-author Asad Loya, MD, from Baylor College of Medicine, who suggested that the temporary pro-inflammatory state induced by cataract surgery could accelerate diabetic retinopathy. Additionally, postoperative changes in vascular endothelial growth factor (VEGF) and other growth factors might promote angiogenesis, potentially worsening retinopathy.

The full report offers additional context as well as a more detailed look at the study’s findings and limitations.