Risk of Progression of Nonproliferative to Proliferative Diabetic Retinopathy after Cataract Surgery

Abstract

Purpose

To assess the influence of modern cataract surgery on the progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes (T2D).

Design

A retrospective analysis of aggregated healthcare data from June 2004 to June 2024 within the TriNetX U.S. collaborative research network.

Subjects

Patients 18 years or older with T2D and NPDR who either underwent routine cataract surgery or did not receive cataract surgery.

Methods

We used the TriNetX integrated analytics platform to analyze data from U.S. healthcare organizations and conducted propensity score matching (PSM) to balance baseline demographic and clinical characteristics. We performed analysis by eye. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) and performed a sensitivity analysis evaluating patients with at least 5 years of T2D before cataract surgery.

Main Outcome Measures

Risk of first-time PDR diagnosis, vitreous hemorrhage (VH), tractional retinal detachment (TRD) or combined tractional and rhegmatogenous retinal detachment (CTRD), and a composite outcome at 1 year in patients who underwent cataract surgery relative to those who did not.

Results

Post-PSM, there were 7178 patients in the study (n = 3589) and control (n = 3589) cohorts for right eye analysis; increased 1-year risks of PDR without complications (HR, 1.45; 95% CI, 1.09–1.92), VH (HR, 1.92; 95% CI, 1.13–3.25), and the composite outcome (HR, 1.49; 95% CI, 1.13–1.96) were observed in operated eyes. Left eye analysis included 7232 patients in the study (n = 3616) and control (n = 3616) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.58; 95% CI, 1.17–2.13), VH (HR, 2.12; 95% CI, 1.23–3.66), and the composite outcome (HR, 1.60; 95% CI, 1.21–2.13) were observed in operated eyes. Sensitivity analysis of those with at least 5 years of T2D included 4976 patients in the study (n = 2488) and control (n = 2488) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.52; 95% CI, 1.06–2.19), VH (HR, 2.50; 95% CI, 1.20–5.20), and the composite outcome (HR, 1.75; 95% CI, 1.22–2.51) were observed in operated eyes. There was no significant difference in the risk for TRD or CTRD in all analyses (all P > 0.05).

Conclusions

Modern cataract surgery was associated with progression from T2D NPDR to PDR within 1 year postoperatively.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.