Cataract surgery in patients with diabetes was associated with an increased risk of incident diabetic retinopathy and disease progression, particularly within the first postoperative year, supporting consideration of cataract surgery as a clinically relevant risk window for enhanced retinal monitoring.
Key Findings
Results
Cataract surgery was associated with a significantly higher risk of incident diabetic retinopathy within 1 year.
In the 1:2 matched cohort, the adjusted OR for incident DR was 3.40 (95% CI 2.65 to 4.36) within 1 year after the index date.
Incident DR was defined as new-onset non-proliferative DR (NPDR) or proliferative DR (PDR).
Similar findings were observed in the 1:1 propensity score-matched analysis.
Outcomes were identified using diagnostic codes recorded at least twice in outpatient visits or once during hospitalisation.
Results
Cataract surgery was associated with a significantly higher risk of diabetic retinopathy progression within 1 year.
In the 1:2 matched cohort, the adjusted OR for DR progression was 3.11 (95% CI 2.47 to 3.92) within 1 year.
DR progression was defined as transition from no DR to NPDR/PDR or from NPDR to PDR.
Absolute event rates at 1 year showed DR progression in approximately 3.1% of patients undergoing surgery compared with 1% in the non-surgical group.
Similar findings were observed in the 1:1 propensity score-matched analysis.
Results
Increased risk of DR incidence and progression was also observed within 6 months after cataract surgery.
The primary outcomes were assessed at two time points: within 6 months and within 1 year after the index date.
Both 6-month and 1-year analyses demonstrated elevated risk associated with cataract surgery.
The risk was described as particularly elevated within the first postoperative year.
Results
More intensive antidiabetic treatment was associated with increased risk of DR incidence and progression in the surgical group.
Increased risk was associated with more intensive antidiabetic treatment among patients undergoing cataract surgery.
This finding was noted alongside the primary surgical risk association.
The study used a nationwide administrative claims database covering more than 99% of the Taiwan population with follow-up from 2010 to 2021.
Methods
After a two-stage matching process, 7,837 matched pairs of diabetic patients with cataract were analysed.
A total of 15,360 patients who underwent first-time cataract surgery and 15,846 patients without surgery were initially identified.
Matching involved two stages: 1:2 age-matching and sex-matching followed by 1:1 propensity score matching.
Adult patients aged 20 years or older with diabetes mellitus and cataract were included.
Patients with prior cataract surgery before the first recorded cataract diagnosis were excluded.
The study used a nationwide administrative claims database in Taiwan covering more than 99% of the population, with longitudinal follow-up from 2010 to 2021.
Conclusions
The authors conclude that surgical history should be incorporated into diabetic retinopathy risk stratification and screening strategies.
The findings support consideration of cataract surgery as 'a clinically relevant risk window for enhanced retinal monitoring.'
Incorporating surgical history into DR risk stratification 'may improve early detection and inform postoperative care pathways.'
The elevated risk was described as particularly concentrated within the first postoperative year.
What This Means
This research suggests that people with diabetes who undergo cataract surgery face a notably higher risk of developing diabetic retinopathy (damage to the blood vessels in the retina) or experiencing worsening of pre-existing retinopathy in the year following their operation. Using data from Taiwan's national health database — which covers over 99% of the population — researchers followed more than 7,800 matched pairs of diabetic patients with cataracts over an 11-year period, comparing those who had surgery with those who did not. They found that surgical patients were about three times more likely to develop new diabetic retinopathy or progress to a more severe stage within one year, with roughly 3.1% of surgical patients experiencing progression compared to about 1% of non-surgical patients.
The study is observational and based on administrative records, meaning it identifies an association rather than proving that surgery directly causes retinopathy to worsen. Some of the increased risk may reflect the fact that surgery makes it easier to examine the back of the eye, leading to detection of previously undiagnosed retinopathy. However, it is also biologically plausible that surgical trauma, inflammation, or changes in light exposure to the retina after removing a cloudy lens could contribute to retinal disease activity.
This research suggests that the period following cataract surgery may be an especially important time for diabetic patients to have their retinas closely monitored. Clinicians may want to consider a patient's surgical history when deciding how frequently to screen for diabetic retinopathy, and more proactive post-operative eye checks could help catch any retinal changes early. Patients with diabetes who are planning or have recently had cataract surgery may benefit from discussing enhanced retinal monitoring with their eye care providers.
Chang Y, Wang J, Chen W, Chiu C. (2026). Association between cataract surgery and diabetic retinopathy incidence and progression: an 11-year population-based retrospective cohort study.. BMJ open. https://doi.org/10.1136/bmjopen-2026-120170