How does diabetes shape the landscape of cataract development and surgical success? a systematic review and meta-analysis.

backgroundDiabetes mellitus (DM) is a chronic metabolic disorder associated with severe complications, including cataracts, a leading cause of blindness. Diabetic patients are at a higher risk of developing cataracts earlier and experiencing poorer surgical outcomes. While cataract surgery is effective, limited research has explored its impact on diabetic patients. This study aims to analyze post-cataract surgery outcomes in diabetics using a meta-analysis approach, addressing gaps in existing research and evaluating the influence of advancements in diabetes management on surgical recovery.

methodThis systematic review and meta-analysis followed PRISMA guidelines to assess the impact of diabetes on cataract surgery outcomes. Quality assessment employed the ROBINS-I tool, ROB2, and Newcastle-Ottawa Scale. Statistical synthesis was performed via STATA 18 and Review Manager 5.4.1. The outcome measures include the incidence of cataract development, post-surgical visual acuity, proportion of good vision outcomes, central retina thickness, and post-surgical complications.

resultsNine hundred eighty-six articles were identified, and 30 met the inclusion criteria. Key risk factors for cataract in people with diabetes were high HbA1c, longer diabetes duration, and retinopathy. Our pooled effect size indicated that non-diabetics had significantly better BCVA post-surgical outcomes than people with diabetes, logMAR 0.07 (SMD 0.07, 95% CI: 0.01, 0.12; p = 0.02). Cataract surgery among non-diabetic patients was significantly associated with good visual acuity compared to poor visual outcomes (OR 42.09, 95% CI: 13.92, 127.33; p < 0.00001). Conversely, central retinal thickness (CRT) was comparable in diabetic and non-diabetic patients (MD -0.18 µm, 95% CI: -3.44 µm, 3.07 µm; p = 0.91). The incidence of macular edema among patients after cataract surgery was 49% (0.49, 95% CI: 0.23, 74; p = 0.01). Diabetic patients were significantly associated with pigment dispersion than non-diabetics post-cataract surgery (OR 2.91, 95% CI: 1.15, 7.31; p = 0.02), striate keratopathy (OR 1.92 95% CI: 1.16, 3.17; p = 0.01), and posterior capsular opacity (OR 2.92 95% CI: 1.80, 4.72; p < 0.00001).

conclusionCataract surgery among diabetic patients was associated with higher risks of complications like macular edema, striate keratopathy, and posterior capsular opacity. Additionally, non-diabetic patients were associated with better BCVA and good visual outcomes compared to diabetic patients post-cataract surgery.