Risk of Progression of Non-Proliferative to Proliferative Diabetic Retinopathy Following Cataract Surgery.

Abstract

Purpose: To assess the influence of modern cataract surgery on the progression from non-proliferative 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 United States 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 US healthcare organizations and conducted propensity score matching (PSM) to balance baseline demographic and clinical characteristics. We performed analysis by eye. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) 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.