Cataract Surgery May Be Safe Beyond A1c Cutoffs

Medscape

09-05-2025

Cataract surgery was not associated with an increased risk for postoperative endophthalmitis or serious systemic adverse events in patients with diabetes, even when preoperative A1c levels were poorly controlled and exceeded 11.3%.
METHODOLOGY:
Researchers conducted a retrospective, longitudinal cohort study to explore the relationship between cataract surgery and the risk for postoperative endophthalmitis and serious systemic adverse events in patients with diabetes.
They examined medical records of 94,952 men and women, aged 18 years or older, with type 1 or type 2 diabetes who underwent phacoemulsification cataract surgery and were stratified by A1c levels: Good (< 7%), moderate (7%-8.4%), poor (8.5%-11.3%), and very poor (> 11.3%) control.
Patients in each group of A1c levels were matched by propensity score analysis with individuals without diabetes who underwent cataract surgery.
To analyze the risk for serious systemic adverse events — mortality, stroke, transient ischemic attack, major cardiovascular events, and a composite of these events — the researchers compared 12,835 patients with diabetes who underwent cataract surgery with those who had similar A1c levels and a record of a routine eye examination but did not undergo the procedure.
In both analyses, A1c documentation was required to have occurred within 3 months prior to cataract surgery.
TAKEAWAY:
The 30-day risk for postoperative endophthalmitis did not differ across A1c levels between patients with diabetes and people without the condition (good control: hazard ratio [HR], 0.62; 95% CI, 0.30-1.27; moderate control: HR, 1.08; 95% CI, 0.44-2.66; poor control: HR, 1.36; 95% CI, 0.43-4.28; and very poor control: HR, 2.85; 95% CI, 0.29-27.44).
Similarly, the risk for serious systemic adverse events within 30 or 90 days after cataract surgery showed no difference across A1c levels in patients with diabetes who did or did not undergo cataract surgery.
IN PRACTICE:
'Our findings suggest that preoperative A1c alone should not be a reason to cancel cataract surgery,' the authors wrote.
'A1c should be utilized as measure to inform wider control of hyperglycemia- and diabetes-related systemic comorbidities and that delaying cataract surgery on the numerical basis of elevated A1c is not necessary,' they added.
SOURCE:
This study was led by Zain S. Hussain, MD, and Ahmed F. Shakarchi, MD, MPH, from the Harvey and Bernice Jones Eye Institute at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. It was published online on May 3, 2025, in American Journal of Ophthalmology .
LIMITATIONS:
The retrospective design limited the ability of this study to infer causality. Small sample sizes in certain subgroups of A1c resulted in wide CIs for some outcomes, potentially limiting the precision of findings. The control group of patients with diabetes who did not have a diagnosis of cataract may have been healthier, introducing selection bias.
DISCLOSURES:
No funding was reported by this study. The authors reported having no relevant conflicts of interest.