Comparison of Cataract Surgery Outcomes in Patients with Type 1 versus Type 2 Diabetes and Patients without Diabetes.

Abstract

To report outcomes of cataract surgery in type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM) and patients without diabetes (DM). Academic tertiary referral university hospital eye center, Aurora, CO, USA. Retrospective chart review using the University of Colorado Cataract Outcomes Database for all cataract surgeries between 2014-2020. Demographics, ocular history, and postoperative outcomes were compared across groups using general linear and logistic regression modeling with estimating equations to account for some patients having two eyes included. A total of 8117 patients and 13,383 eyes were included. Compared to T2DM eyes undergoing cataract surgery (n=3115), T1DM eyes (n=233) were more likely to have a history of diabetic retinopathy (DR) (60.5% vs 23.6%), p<0.0001), of which proliferative DR was the most common (63.1% vs 42.4%, p<0.0001). T1DM eyes were also more likely to have a history of retinal detachment (RD) (9.0% vs 2.9%, p<0.0001) and prior vitrectomy surgery (12.9% vs 4.0%, p<0.0001). Despite having similar preoperative best-corrected visual acuity (BCVA) as T2DM eyes (logMAR 0.52 vs. 0.44, p=0.092), T1DM eyes had worse BCVA following cataract surgery (logMAR 0.27 vs 0.15, p=0.0003). In a multivariable analysis, a history of proliferative DR and prior RD were significant predictors of worse postoperative BCVA (p<0.0001) but type of DM was not (p=0.894). T1DM eyes have worse visual outcomes after cataract surgery compared to T2DM eyes. Worse postoperative visual acuity was associated with worse preoperative diabetic retinopathy and history of retinal detachment rather than type of DM.