Intraoperative complications and visual outcomes of cataract surgery in diabetes mellitus: a multicenter database study

PURPOSE: To compare the visual outcome and the rate of intraoperative complications in eyes of diabetic and non-diabetic patients undergoing phacoemulsification over 15 years DESIGN: Retrospective clinical cohort study METHODS: Data of 179,159 eyes that underwent phacoemulsification at 8 centers were classified based on the presence or absence of diabetes mellitus. Visual acuity (VA) was defined as the best value of uncorrected or corrected distance measure available. For the VA analysis, eyes with co-pathologies, or combined surgical procedures were further excluded, leaving a subset of 90,729 eyes. Main outcome measures were logarithm of the minimum angle of resolution (logMAR) VA at 4-12 weeks postoperatively, and rate of intraoperative complications.

RESULTS: Cataract surgery in eyes of diabetic patients was associated with an improvement in mean VA of 0.48 LogMAR (5 Snellen lines). Mean postoperative VA was slightly worse in diabetic compared to non-diabetic group (logMAR 0.23 vs. 0.13; Snellen 20/30 vs. 20/25; p < 0.0001) and the proportions of eyes achieving a visual gain of ≥3 Snellen lines (≥ 0.3 logMAR) was lower in the diabetic group (56.6% vs. 63.5%; p < 0.0001). There was a linear relationship between diabetic retinopathy severity and worse postoperative visual acuity (β coefficient 0.098 to 0.288; p < 0.0001). We observed higher rates of posterior capsule rupture (2.3% vs.1.6%; p <0.001) and dropped nuclear fragments (0.3% vs.0.2%; p<0.001) in the diabetic group.

CONCLUSIONS: Postoperative VA negatively correlated with diabetes and diabetic retinopathy severity. Eyes of diabetic subjects had higher risks of posterior capsular rupture.