Surgical Outcomes of Cataract Surgery Following Rapid Glycemic Control During Preoperative Period

Purpose: To evaluate the effects of rapid preoperative glycemic control on outcomes of cataract surgery for type 2 diabetes patients with high HbA1c levels. Methods: The medical data of consecutive cohort patients with type 2 diabetes who underwent cataract surgery were respectively reviewed between January 2023 and May 2024. The rapid control group consisted of 152 patients (222 eyes) with HbA1c > 9.0% following rapid glycemic control (average duration: 17.3 ± 6.6 days), and the basic control group consisted of 111 patients (162 eyes) with HbA1c < 7.0%. Complications and visual outcomes were analyzed between the two groups during the 6-month postoperative follow-up. Results: Macular edema and vitreous hemorrhage were the main postoperative complications in rapid control group (11.7%) and basic control group (4.9%) ( P = 0.021). Linear Mixed-effects Models analysis showed that rapid glycemic correction (Odds ratio [OR] = 6.525, 95% confidence interval [CI] = 2.927– 14.547, P < 0.001) and moderate to severe non-proliferative diabetic retinopathy (OR = 0.119, 95% CI = 0.054– 0.263, P < 0.001) were the main risk factors of complications. However, only 3.8% of patients with timely intervention for diabetic retinopathy developed severe complications in rapid control group ( P = 0.019). Besides, other complications including endophthalmitis, hyphema or incision leakage were not observed in rapid control group. At the final follow-up, the average best correction visual acuity in rapid control group was 0.30 ± 0.32 logMAR, with significant improvement compared with 1.26 ± 0.74 logMAR before surgery ( P < 0.0001). Conclusion: It seems to be unnecessary to prolong the duration of glycemic control before cataract surgery from safety and effectiveness. Timely intervention may prevent the severe complications of diabetic retinopathy after cataract surgery following rapid glycemic control. Keywords: type 2 diabetes mellitus, HbA1c, rapid glycemic control, cataract surgery, diabetic retinopathy, complications