The impact of diabetes mellitus and diabetic retinopathy on prognosis and complications after cataract surgery: Retrospective cohort study.

To evaluate the impact of diabetes mellitus (DM)-related factors, including disease duration, HbA1c levels, and diabetic retinopathy (DR) staging, on acute postoperative inflammation, visual recovery, and complication risks following cataract surgery. This retrospective cohort study included 780 cataract patients categorized into 3 groups: DR DM (n = 117, with DR per ETDRS criteria), non-DR DM (n = 328, T2DM without DR), and non-DM controls (n = 335). Matching was done via propensity score (age, sex, diabetes duration). Data on diabetes characteristics, systemic comorbidities, and surgical outcomes were extracted. Inflammation was assessed by anterior chamber reaction (SUN criteria) and tear cytokines (monocyte chemoattractant protein-1 [MCP-1], interleukin-6 [IL-6]) measured pre- and postoperatively. Outcomes included postoperative complications and visual recovery (logarithm of the minimum angle of resolution [ΔlogMAR]). Analyses used logistic regression, ANOVA, and chi-square tests. The DR DM group exhibited the highest rates of acute anterior chamber inflammation (15.4%), significantly elevated in proliferative diabetic retinopathy (PDR) patients (18.3%, P < .01). Tear MCP-1 and IL-6 levels peaked at 1 week post-surgery, with PDR patients showing markedly higher concentrations (MCP-1: 1023.6 ± 124.8 pg/mL vs non-proliferative diabetic retinopathy: 835.4 ± 112.5 pg/mL; IL-6: 52.5 ± 12.9 pg/mL vs 43.7 ± 11.4 pg/mL; P < .001). Visual recovery (ΔlogMAR) was significantly less in PDR patients (0.27 ± 0.25) compared to non-DR DM (0.12 ± 0.16, P < .001). Complication rates were highest in DR DM patients (25.7%), particularly macular edema (18.2%) and DR progression (9.3%). HbA1c > 9% and diabetes duration > 10 years were independently associated with poor visual recovery (odds ratio = 2.0, P < .001) and elevated macular edema risk (odds ratio = 2.3, P < .001). DM-related factors, especially PDR and poor glycemic control, significantly influence acute postoperative inflammation, short-term visual recovery, and complication risks within the 3-month follow-up period. However, this duration is insufficient to evaluate long-term outcomes such as posterior capsular opacification or persistent macular edema. These findings underscore the need for optimized preoperative glycemic management and targeted postoperative care to improve early outcomes in DM patients undergoing cataract surgery. Future research with extended follow-up should focus on inflammation-targeted interventions and long-term prognosis.