Cataract surgery in patients with diabetes mellitus: preoperative, intraoperative, and postoperative considerations

PURPOSE OF REVIEW: Diabetes mellitus may influence different stages of cataract surgery, from preoperative evaluation to postoperative recovery. With the rapid increase in the global prevalence of diabetes, understanding evidence-based strategies for optimizing surgical outcomes is critical. RECENT FINDINGS: Studies have found that fixed glycated hemoglobin (HbA1c) thresholds alone should not be used to determine the timing of surgery. Instead, a macula-first approach, integrating retinal co-management and optical coherence tomography (OCT) for diabetic patients, allows for tailored decision-making. Key advancements include ocular surface optimization to enhance biometry accuracy, proactive perioperative anti-inflammatory regimens combining NSAIDs and corticosteroids, and selective use of intravitreal anti-VEGF or corticosteroid therapy for diabetic macular edema (DME). Lens choice should refrain from multifocal optics in eyes with diabetic macular diseases. Emerging equity frameworks underscore the need to replace systemic cut-offs with risk-based protocols to enhance access and outcomes. SUMMARY: Modern cataract surgery in patients with diabetes requires an individualized retina-integrated approach that emphasizes inflammation control and macular preservation. Embedding equity-driven, OCT-based pathways ensures that surgical excellence extends to populations most affected by diabetes-related vision loss.