Impact of Uncomplicated Cataract Surgery on Central Retinal Thickness Changes in Diabetic Patients - Short-Term Analysis

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Algorinees, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7399330/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To evaluate short-term changes in central retinal thickness (CRT) after uncomplicated cataract surgery in diabetic patients and assess the influence of diabetic retinopathy severity on postoperative retinal response. Methods This prospective, observational study included 102 eyes of 102 type 2 diabetic patients undergoing cataract surgery at a single tertiary center. Patients were divided into two groups: Group I (n = 51) without diabetic retinopathy and Group II (n = 51) with diabetic retinopathy. CRT was assessed using spectral-domain optical coherence tomography (SD-OCT) at baseline and postoperatively at weeks 1, 6, and 12. Changes in CRT ≥ 10 µm, ≥ 29 µm, and ≥ 50 µm were analyzed. Associations with systemic parameters such as duration of diabetes and HbA1c were also evaluated. Results CRT significantly increased from baseline in both groups, peaking at 6 weeks postoperatively (Group I: median 263 µm; Group II: median 270 µm; p = 0.001). At 6 weeks, 27.5% of Group I and 74.5% of Group II patients developed CRT increases ≥ 10 µm (p < 0.001), with 21.6% of Group II showing increases ≥ 29 µm and 7.8% ≥50 µm. No significant differences in best corrected visual acuity (BCVA) loss were observed between groups (p = 0.265). Among Group II, CRT elevation was greatest in patients with more severe stage of diabetic retinopathy. Higher HbA1c and longer diabetes duration correlated positively with CRT increase at week 6 (r = 0.318 and r = 0.201, respectively). Conclusion Subclinical CRT changes were observed after the cataract surgery in diabetic patients, particularly in those with existing diabetic retinopathy (DR). The severity of DR correlates with the magnitude of retinal thickening, peaking at 6 weeks. Despite CRT elevation, visual acuity remained stable in the short term. Duration of diabetes and elevated HbA1c were identified as systemic risk factors. These findings underscore the importance of OCT monitoring and DR staging in perioperative diabetic care. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Medical research Cataract surgery diabetic retinopathy central retinal thickness optical coherence tomography Figures Figure 1 Figure 2 Summary What was known before: Around one in five people who undergo cataract surgery have diabetes. If a person has diabetes, cataract surgery can increase intravitreal inflammatory mediators and develop CRT changes postoperatively. What this study confirms: CRT changes following uncomplicated cataract surgery in diabetic patients, with a focus on the influence of NPDR severity. CRT peaked at 6 weeks, particularly in patients with severe NPDR, aligning with previous literature that highlights this postoperative timeframe as the peak risk period for macular edema. No significant short-term decrease BCVA was observed. High resolution SD-OCT has a major rule for detecting subclinical CRT changes. Systemic factors such as longer diabetes duration, elevated HbA1c were associated with greater CRT increases. Introduction Diabetes mellitus DM is a chronic metabolic disease characterized by sustained hyperglycemia leading to macro and microvascular complications [ 1 ]. The prevalence of diabetes is high and is continuously increasing. In 2019, the International Diabetes Federation estimated that 240 million people were living with the disease (a prevalence of 9.6%): this will rise to 356 million (11.1% prevalence) in 2045. This prevalence increases significantly with age, reaching over 20% in elderly subjects. Chronic hyperglycemia affects cardiovascular, renal, neural systems and visual system with no exception [ 2 ]. Diabetes affects all ocular tissues, including the crystalline lens [ 3 ]. A large proportion of people with diabetes will experience accelerated cataract development and require cataract surgery at an earlier age compared with non-diabetics [ 2 ]. Cataract is the clouding of the crystalline lens and can be further differentiated into types, such as nuclear, cortical, and posterior subcapsular cataracts. Different types of mechanisms are proposed for the pathogenesis of cataract. Hyperglycemia leads to the production of advanced glycation end products, increased oxidative stress, and increased activation of the polyol pathway which compromises blood–aqueous or blood–retina barriers (BRB) [ 4 ]. Phacoemulsification is among the most frequently performed surgical procedures in modern ophthalmology. It is considered a safe and effective procedure with significant improvement in visual function. Diabetic patients can be associated with the development or worsening of diabetic retinopathy (DR) and macular edema due to the inflammatory insult in the aqueous and vitreous, which leads to further breakdown of the already compromised blood retinal barrier [ 5 , 6 ]. The presence of retinopathy increases the risk of developing macular edema after cataract surgery compared with healthy eyes, according to the British retrospective database study [ 7 ]. Apart from retinopathy presence, long duration of diabetes, poor glycemic control, baseline increased in central retinal thickness (CRT), intraoperative complications, associations with kidney dysfunction and hypertension (HTA) are considered as risk factors of developing and worsening of DR and macular edema postoperatively as well [ 4 ]. Optical coherence tomography (OCT) is a noninvasive imaging technique that uses visible and infrared electromagnetic waves to provide detailed, cross-sectional images of body tissues. OCT has widespread application in ocular imaging to diagnose and monitor various ophthalmic pathologies [ 8 ]. It provides high-resolution imaging of the retina and quantitative assessment of changes in retinal thickness or edema [ 9 ]. The aim of the study was to assess the Central Retinal Thickness (CRT) changes after cataract surgery in diabetic patients with different stages of DR. Methods This was a prospective, comparative observational study carried out at the Eye Clinic, University Clinical Center of the Republic of Srpska (Bosnia and Herzegovina) between January and October 2023. Ethical approval was obtained from the institutional committee, and all procedures adhered to the principles of the 1964 Declaration of Helsinki. Written informed consent was obtained from every participant before inclusion. Study groups Patients aged 55 years or older with type 2 diabetes and cataract were enrolled and classified into two groups: Group I (51 patients) with diabetes but no diabetic retinopathy, and Group II (51 patients) with varying stages of diabetic retinopathy. Cataract severity was graded according to the Lens Opacities Classification System III (LOCS III), while diabetic retinopathy was staged using the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Study Design Before surgery, each patient received a comprehensive baseline eye examination, which included best-corrected visual acuity (Snellen chart), intraocular pressure measurement (Goldmann tonometry), slit-lamp biomicroscopy, and dilated fundus inspection. Posterior segment assessment comprised color fundus photography (Zeiss Clarus 7000) and macular imaging with spectral-domain OCT (Zeiss Cirrus HD-OCT 6000). A 6 × 6 mm macular cube scan (512 × 128 pattern) centered on the fovea was acquired, and central retinal thickness (CRT) was quantified using the ETDRS map within a 500-um ring around the foveola. All surgeries were performed by a single experienced surgeon under topical anesthesia. The standard procedure involved a 2.75 mm clear corneal incision, continuous curvilinear capsulorhexis, and phacoemulsification using the Bausch & Lomb Stellaris system (2016 model). A foldable, one-piece hydrophilic acrylic intraocular lens (AKREOS ADAPT AO) was implanted in all cases. At the conclusion of surgery, an intracameral antibiotic was administered. Postoperatively, patients received topical corticosteroid drops; nonsteroidal anti-inflammatory drugs (NSAIDs) were intentionally omitted to eliminate their potential influence on cystoid macular edema outcomes. Follow-up assessments were conducted at 1, 6, and 12 weeks postoperatively. At each visit, patients underwent BCVA testing, slit-lamp biomicroscopy, fundus examination, and OCT imaging. Baseline demographic and systemic parameters (age, sex, diabetes duration, treatment type, and HbA1c level) were recorded. Mean phacoemulsification time was documented during surgery. Inclusion criteria Eligible participants included individuals with type 2 diabetes who had cataract resulting in a best-corrected visual acuity (BCVA) of 0.5 or less, and cataract graded at least N3 or P3 on the LOCS Ill scale. Exclusion criteria Exclusion criteria were: severe cataract with dense nuclei that precluded preoperative OCT imaging; intraoperative complications such as posterior capsule rupture; proliferative diabetic retinopathy (with or without prior panretinal photocoagulation); preexisting subclinical central retinal thickening or diabetic macular edema; the presence of epiretinal membrane or vitreomacular traction; coexisting ocular diseases including glaucoma or uveitis; and any intraocular surgery performed within the preceding six months. Definition of Clinically Significant Retinal Thickening Changes in CRT < 10 µm was considered as an artefact or part of the normal fluctuation. A clinically significant worsening was defined as an increase in CRT ≥ 50 µm on OCT imaging compared to baseline values in both groups. Statistical analysis Data was collected, stored, and managed in a spreadsheet using Microsoft Excel 2010® software. Data were analyzed and figures prepared using SPSS® version 23.0 (IBM Corp, Armonk, NY, USA). Descriptive analysis was done where categorical variables were reported as frequencies and percentages and Chi-squared tests done to test the differences between the Group I and Group II. For the continuous variables, tests for normality were done using Shapiro-Wilk test and Q-Q plots; the data were not normally distributed and were reported as medians, interquartile range (IQR). Consequently, Kruskal-Wallis and Mann-Whitney were used to test the differences between the groups and Friedman and Wilcoxon tests used for within the groups’ comparisons (applying Bonferroni correction where necessary). Additionally, Spearman’s correlation was used to correlate the CRT measurement at 6 weeks with duration of disease in years and HbA1c (%) levels. Any output with a p below 0.05 was interpreted as an indicator of statistical significance. Results A total of 102 eyes from 102 patients were included in the study, with 51 eyes each in Group I (diabetic patients without DR) and Group II (diabetic patients with DR). Participant’s demographics (Table 1 ) were similar in both groups. Mean age was 65 years (IQR: 63–69) in both groups. The median duration of disease was 11 years in both groups (IQR: 11–12). Most patients were on oral antidiabetic drugs (OAD), 92.2% patients in Group I, and 84.3% patients in Group II. Insulin use was higher in Group II (15.7%), but the difference was not statistically significant ( p = 0.357). The median HbA1c value was 6.9 (IQR: 6.5-7) in Group I and 6.9 (IQR: 6.5–7.2) in Group II. No differences in the rest of baseline parameters were statistically significant. Table 1 Demographics and baseline characteristics Characteristic ALL GROUP I GROUP II P value Eyes 102 51 51 --- Gender, male: female (%) 58.8:41.2 60.8:39.2 56.9:43.1 0.687 ¥ Age in years, median (IQR) 65 (63–69) 65 (63–69) 65 (63–69) 0.795 α Duration of disease in years, median (IQR) 11 (11–12) 11 (11–12) 11 (11–12) 0.146 α Therapy; insulin: OAD (%) 11.8:88.2 7.8:92.2 15.7:84.3 0.357 ¥ Hemoglobin A1c (%), median (IQR) 6.9 (6.5-7) 6.9 (6.5-7) 6.9 (6.5–7.2) 0.580 α Average Phaco time, median (IQR) 0.55 (0.48–0.57) 0.55 (0.48–0.57) 0.55 (0.48–0.57) 0.957 α BCVA, decimal equivalent, median (IQR) 0.3 (0.3–0.4) 0.4 (0.3–0.4) 0.3 (0.3–0.4) 0.358 α CRT at baseline (µm) median (IQR) 255 (245–260) 255 (245–260) 255 (245–260) 0.666 α ¥ Chi-squared test; α Mann-Whitney test CRT was measured in micrometers (µm) at baseline, week 1, week 6, and week 12 postoperatively, in all patients (n = 102), in Group I and in Group II. Within Group Analysis: The change in CRT (Table 2 ) was statistically significant in both groups separately compared to baseline. In week. 1 postoperatively, CRT remained unchanged. Comparing to the baseline, the biggest CRT changes was recorded in week 6 in both groups with median 263 µm (IQR:255–269) in the Group 1 and 270 µm (IQR:260–280) in Group II. CRT slowly decreased in week 12. Between Group Analysis: Comparing the CRT changes between the groups (Table 2 ), the difference was statistically significant in week 6 ( p = 0.001) and remained significant in week 12 (p = 0.006). Table 2 CRT changes Time ALL median (IQR) GROUP I median (IQR) GROUP II median (IQR) P value α CRT (µm) Baseline 255 (245–260) 255 (245–260) 255 (245–260) 0.666 CRT (µm) 1 week 255 (245–260) 255 (245–260) 255 (245–260) 0.871 CRT (µm) 6 weeks 265 (255–275) 263 (255–269) 270 (260–280) 0.001* CRT (µm) 12 weeks 260 (250–269) 259 (250–265) 260 (255–270) 0.006* P value € < 0.001* < 0.001* < 0.001* α Mann-Whitney test; € Friedman test; *Statistically significant at 5% level of significance During the 6 weeks after the cataract surgery (Table 3 ), CRT worsened ≥ 10 µm in 14 patients (27,5%) in Group I and in 38 patients (74,5%) in Group II with statistical significance p < 0.001. CRT worsened ≥ 29 µm in 11 patients (21,6%) in Group II with statistical significance p = 0.001. 4 patients (7,8%) in Group II had clinically significant CRT increased ≥ 50 µm. Median BCVA loss was the same in both groups 0.6 (IQR: 0.6–0.7) with no statistical significance p = 0.265. Table 3 Summary of results in Groups I and II in week 6 Group I Group II P value Eyes 51 51 ≥ 10 µm ¥ 27.5% (14 eyes) 74.5% (38 eyes) < 0.001* ≥ 29 µm ¥ 0.0% (0 eyes) 21.6% (11 eyes) 0.001* ≥ 50 µm ¥ 0.0% (0 eyes) 7.8% (4 eyes) 0.043* BCVA loss (de), median (IQR) α 0.6 (0.6–0.7) 0.6 (0.6–0.7) 0.265 ¥ Chi-squared test; α Mann-Whitney test; *Statistically significant at 5% level of significance Relations between duration of diabetes and HbA1C values with CRT changes in week 6 were tested (Fig. 1 ). Patients with longer duration of diabetes (r = 0.201, p = 0.042) and higher level of HbA1C (r = 0.318, p = 0.001) tend to have grater CRT values with statistically significant differences. Patients in Group II (with non-proliferative diabetic retinopathy, NPDR) were further divided into three subgroups based on DR severity: mild, moderate, and severe (Table 4 ). CRT increased progressively with DR severity, peaking in week 6 postoperatively. Patients with severe NPDR had the highest CRT values in both week 6 and 12, with statistically significant differences between the mild, moderate, and severe groups ( p < 0.001 at 6 weeks; p = 0.010 at 12 weeks). Table 4 CRT changes by Diabetic Retinopathy Severity (Group II) Mild (n = 18) median (IQR) Moderate (n = 18) median (IQR) Severe (n = 15) median (IQR) P value £ OCT (µm) Baseline 255 (245–260) 250 (243.75-256.25) 255 (250–260) 0.254 OCT (µm) 1 week 255 (245–260) 252.5 (243.75-261.25) 260 (250–265) 0.275 OCT (µm) 6 weeks 260 (255–270) 270 (260-282.5) 285 (275–300) < 0.001* OCT (µm) 12 weeks 260 (250-266.25) 260 (255-272.5) 270 (266-278.75) 0.010* £ Kruskal-Wallis test; € Friedman test The progression of median CRT after cataract surgery, stratified by diabetic retinopathy severity (Fig. 2 ). In contrast to severe NPDR, mild NPDR cases showed minimal CRT elevation. Discussion Diabetes significantly increases the risk and progression of cataracts, making cataracts a major cause of visual impairment in diabetic patients. Although cataract surgery is effective, diabetic patients face higher complication rates compared to non-diabetics [ 10 ]. Cataract surgery increases the risk of retinopathy progression and postoperative macular edema in diabetic patients [ 7 ]. This study investigated short-term changes in central retinal thickness (CRT) following uncomplicated cataract surgery in diabetic patients, with a specific focus on how varying stages of non-proliferative diabetic retinopathy (NPDR) influence retinal response. Diabetic patients without previous DR (Group I) show the CRT changes postoperatively with statistically significant from baseline (p < 0.001). 14 patients (27,5%) increase CRT ≥ 10µm in week 6. Several studies show that even diabetic patients without retinopathy have a higher risk of developing macular edema post operatively [ 11 , 12 , 13 ]. British Retrospective Database (78,000 + eyes) was the large-scale retrospective cohort study which analyzed data from over 78,000 cataract surgeries in the United Kingdom to investigate the risk factors for developing postoperative macular edema. The key findings were that diabetic patients without any clinical signs of diabetic retinopathy still had a 1.8 times higher risk of developing macular edema after cataract surgery compared to non-diabetic patients [ 8 ]. On the other side, patients with preexisting DR had a higher risk to increasing CRT postoperatively (Group II). Compared to the diabetic patients without retinopathy (Group I) difference was statistically significant in week 6 (p < 0.001) and in week 12 (p < 0.006). 11 patients (21,6%) increased CRT ≥ 29µm and 4 patients (7,8%) increased CRT ≥ 50µm in Group II. Moreover, an increase of the CRT has previously been reported in diabetic eyes, which is similar to the results of our research [ 14 , 15 , 16 ]. Chen et al. [ 4 ] and Chu et al. [ 7 ] reported a higher risk macular edema in diabetic eyes, particularly in the presence of retinopathy. Our results further support the observation that the inflammatory and vascular responses in diabetic retinas are more pronounced due to a compromised blood-retinal barrier. Even though no patients in our cohort received prophylactic NSAID therapy [ 17 ], the incidence of macular edema in Group I remained low, give the importance of retinopathy stage as a critical risk factor. Patients with severe NPDR demonstrated the highest CRT values, peaking at a median of 285 µm in week 6 and remaining elevated in week 12. By contrast, patients with mild or moderate NPDR showed smaller CRT increases, with partial resolution in month 3. These results are consistent with previous literature indicating that DR severity correlates with the degree of central retinal thickening [ 18 , 19 ]. In our study the central retinal thickness (CRT) increased peaking at 6 weeks after cataract surgery. Previous reports have also shown that the incidence of macular edema peaks approximately 4–6 weeks after uneventful cataract [ 20 ]. Despite increased CRT, no significant difference in BCVA loss mean was observed between patients with and without DR (p = 0.265). CRT changes (10 ≤ from baseline) led to no detectable BCVA reduction in the short term [ 21 , 22 , 23 ]. We also found that longer duration of diabetes (> 10 years) and HbA1c (> 5,9%), were independently associated with higher CRT in week 6. Our study confirmed the hypothesis about risk factors that can influence the CRT changes after the uncomplicated cataract surgery in diabetics, explained in the following studies. Yung J. et al. demonstrated the longer duration of diabetes and HbA1C c were risks for macular edema in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity [ 24 ]. Furthermore, Kanzlers P. et al. showed the preoperative HbA1c was independent risk factors for CRT increase 1 month after cataract surgery [ 25 ]. On the other side, Denier C. et al. did not find influence of glycemic control (measured by HbA1C) or duration of diabetes to postoperative increase of CRT which can be related to the low number of patients included in study [ 26 ]. This study has several limitations that should be emphasized. Although the sample size was adequate to detect significant differences between groups, it remains relatively small and was conducted at a single center. The follow-up period was limited to 12 weeks, focusing only on short-term CRT changes. While this timeframe captures the typical peak period for postoperative macular thickening, it may not reflect long-term outcomes. Systemic factors like HbA1c and diabetes duration were analyzed, other important variables such as lipid profile, renal function, hypertension[ 27 ], or inflammatory biomarkers were not included. Additionally, no prophylactic NSAIDs were administered as part of the study protocol. While this helped isolate the natural postoperative response, it does not reflect routine clinical practice where NSAIDs are often used to reduce the risk of macular edema. An increase in CRT often reflects accumulation of fluid in the retina, which may lead to macular edema—the most common cause of poor visual recovery after successful cataract surgery. According to the DRCR.net Cohort (2013) a real-world follow-up of diabetic eyes (without macular edema) undergoing cataract surgery reported a 4% incidence of central-involved edema, with elevated CRT measured by OCT identifying cases even before symptoms appear [ 28 ]. Abbreviations DM diabetes mellitus BRB blood retina barrier DR diabetic retinopathy CRT central retinal thickness OCT optical coherent tomography HTA hypertension LOCS lens opacite classification system ETRDS. early treatment diabetic retinopathy study BCVA best corrected visual acuity NSAID nonsteroidal anti-inflammatory drug HbA1c hemoglobin A1c OAD oral antidiabetic drug NPDR non-proliferative diabetic retinopathy Declarations Ethical Approval Ethical approval for this study was granted by Institutional Ethics Committee of University Clinical Center of Republic of Srpska (No 01-19-238-2/22, date 13 th of July 2022.) and conducted in accordance with the Declaration of Helsinki 1964. Source of Funding This study did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors. Author Contributions Sasa Smolianovic Skocic, Sanela-Sanja Burgic, Rakan M. Algorinees, and Shog K. Alahmed contributed to the conception, design, data collection, analysis, and drafting of the manuscript. All authors critically reviewed the content, approved the final version for submission, and agree to be accountable for all aspects of the work. Consent Informed consent was obtained from all participants in accordance with the guidelines of the Declaration of Helsinki. Declaration of Competing Interests The authors declare that there are no conflicts of interest. References Henriques, J., Vaz-Pereira, S., Nascimento, J. & Rosa, P. C. Diabetic Eye Disease. Acta Med. Port . 28 (1), 107–113 (2015 Jan-Feb). Panozzo, G. et al. Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study. 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Risk factors for development of macular edema after cataract surgery in eyes without preoperative macular edema. Ophthalmology 120 (9), 1843–1851 (2013). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7399330","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":518213735,"identity":"e846ea34-c64f-4bff-b56a-7da2cd339c66","order_by":0,"name":"Sasa Smoljanovic Skocic","email":"","orcid":"","institution":"University Clinical Center of Republic of Srpska","correspondingAuthor":false,"prefix":"","firstName":"Sasa","middleName":"Smoljanovic","lastName":"Skocic","suffix":""},{"id":518213736,"identity":"cb274c4b-45a2-46df-9a22-7e060defb5ae","order_by":1,"name":"Sanela-Sanja Burgic","email":"","orcid":"","institution":"University Clinical Center of Republic of Srpska","correspondingAuthor":false,"prefix":"","firstName":"Sanela-Sanja","middleName":"","lastName":"Burgic","suffix":""},{"id":518213737,"identity":"090616f6-ecbe-4566-bdaa-c09382bcd51b","order_by":2,"name":"Rakan M. 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13:22:12","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83919,"visible":true,"origin":"","legend":"","description":"","filename":"23691be5a2b446778398ba5455b71af01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7399330/v1/bcadf7adcc5eba13e51c04fd.xml"},{"id":92086953,"identity":"b2c8916c-091d-45b1-8acc-42359f31acb6","added_by":"auto","created_at":"2025-09-24 13:06:12","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93980,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7399330/v1/9747df673458af9494d05411.html"},{"id":92088916,"identity":"a4eebc18-81ce-4510-9579-f0bb9846c76d","added_by":"auto","created_at":"2025-09-24 13:22:12","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":175360,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelations- CRT at 6 weeks with Duration of diabetes, HbAIC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*Statistically significant at 5% level of significance\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7399330/v1/0f29147bac7c2d736780cb74.jpeg"},{"id":92088599,"identity":"93fcd6e8-34a5-49fb-9fa8-3d036dfccf93","added_by":"auto","created_at":"2025-09-24 13:14:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":12186,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCRT changes within the Group II\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7399330/v1/2c8a8dd578c5fe73e95d73c8.png"},{"id":93065632,"identity":"ac61271b-c8f3-4b10-b168-f1d6ca55c7e9","added_by":"auto","created_at":"2025-10-08 16:44:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926170,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7399330/v1/6bd380f9-ff90-4147-a898-9176e7be203d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Uncomplicated Cataract Surgery on Central Retinal Thickness Changes in Diabetic Patients - Short-Term Analysis","fulltext":[{"header":"Summary","content":"\u003cp\u003eWhat was known before:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAround one in five people who undergo cataract surgery have diabetes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIf a person has diabetes, cataract surgery can increase intravitreal inflammatory mediators and develop CRT changes postoperatively.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eWhat this study confirms:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCRT changes following uncomplicated cataract surgery in diabetic patients, with a focus on the influence of NPDR severity.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCRT peaked at 6 weeks, particularly in patients with severe NPDR, aligning with previous literature that highlights this postoperative timeframe as the peak risk period for macular edema.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNo significant short-term decrease BCVA was observed.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHigh resolution SD-OCT has a major rule for detecting subclinical CRT changes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSystemic factors such as longer diabetes duration, elevated HbA1c were associated with greater CRT increases.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus DM is a chronic metabolic disease characterized by sustained hyperglycemia leading to macro and microvascular complications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The prevalence of diabetes is high and is continuously increasing. In 2019, the International Diabetes Federation estimated that 240\u0026nbsp;million people were living with the disease (a prevalence of 9.6%): this will rise to 356\u0026nbsp;million (11.1% prevalence) in 2045. This prevalence increases significantly with age, reaching over 20% in elderly subjects. Chronic hyperglycemia affects cardiovascular, renal, neural systems and visual system with no exception [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Diabetes affects all ocular tissues, including the crystalline lens [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA large proportion of people with diabetes will experience accelerated cataract development and require cataract surgery at an earlier age compared with non-diabetics [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCataract is the clouding of the crystalline lens and can be further differentiated into types, such as nuclear, cortical, and posterior subcapsular cataracts. Different types of mechanisms are proposed for the pathogenesis of cataract. Hyperglycemia leads to the production of advanced glycation end products, increased oxidative stress, and increased activation of the polyol pathway which compromises blood\u0026ndash;aqueous or blood\u0026ndash;retina barriers (BRB) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePhacoemulsification is among the most frequently performed surgical procedures in modern ophthalmology. It is considered a safe and effective procedure with significant improvement in visual function. Diabetic patients can be associated with the development or worsening of diabetic retinopathy (DR) and macular edema due to the inflammatory insult in the aqueous and vitreous, which leads to further breakdown of the already compromised blood retinal barrier [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The presence of retinopathy increases the risk of developing macular edema after cataract surgery compared with healthy eyes, according to the British retrospective database study [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eApart from retinopathy presence, long duration of diabetes, poor glycemic control, baseline increased in central retinal thickness (CRT), intraoperative complications, associations with kidney dysfunction and hypertension (HTA) are considered as risk factors of developing and worsening of DR and macular edema postoperatively as well [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOptical coherence tomography (OCT) is a noninvasive imaging technique that uses visible and infrared electromagnetic waves to provide detailed, cross-sectional images of body tissues. OCT has widespread application in ocular imaging to diagnose and monitor various ophthalmic pathologies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It provides high-resolution imaging of the retina and quantitative assessment of changes in retinal thickness or edema [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe aim of the study was to assess the Central Retinal Thickness (CRT) changes after cataract surgery in diabetic patients with different stages of DR.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a prospective, comparative observational study carried out at the Eye Clinic, University Clinical Center of the Republic of Srpska (Bosnia and Herzegovina) between January and October 2023. Ethical approval was obtained from the institutional committee, and all procedures adhered to the principles of the 1964 Declaration of Helsinki. Written informed consent was obtained from every participant before inclusion.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy groups\u003c/h2\u003e\u003cp\u003ePatients aged 55 years or older with type 2 diabetes and cataract were enrolled and classified into two groups: Group I (51 patients) with diabetes but no diabetic retinopathy, and Group II (51 patients) with varying stages of diabetic retinopathy.\u003c/p\u003e\u003cp\u003eCataract severity was graded according to the Lens Opacities Classification System III (LOCS III), while diabetic retinopathy was staged using the Early Treatment Diabetic\u003c/p\u003e\u003cp\u003eRetinopathy Study (ETDRS) criteria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eBefore surgery, each patient received a comprehensive baseline eye examination, which included best-corrected visual acuity (Snellen chart), intraocular pressure measurement (Goldmann tonometry), slit-lamp biomicroscopy, and dilated fundus inspection. Posterior segment assessment comprised color fundus photography (Zeiss Clarus 7000) and macular imaging with spectral-domain OCT (Zeiss Cirrus HD-OCT 6000). A 6 \u0026times; 6 mm macular cube scan (512 \u0026times; 128 pattern) centered on the fovea was acquired, and central retinal thickness (CRT) was quantified using the ETDRS map within a 500-um ring around the foveola.\u003c/p\u003e\u003cp\u003eAll surgeries were performed by a single experienced surgeon under topical anesthesia. The standard procedure involved a 2.75 mm clear corneal incision, continuous curvilinear capsulorhexis, and phacoemulsification using the Bausch \u0026amp; Lomb Stellaris system (2016 model). A foldable, one-piece hydrophilic acrylic intraocular lens (AKREOS ADAPT AO) was implanted in all cases. At the conclusion of surgery, an intracameral antibiotic was administered. Postoperatively, patients received topical corticosteroid drops; nonsteroidal anti-inflammatory drugs (NSAIDs) were intentionally omitted to eliminate their potential influence on cystoid macular edema outcomes.\u003c/p\u003e\u003cp\u003eFollow-up assessments were conducted at 1, 6, and 12 weeks postoperatively. At each visit, patients underwent BCVA testing, slit-lamp biomicroscopy, fundus examination, and OCT imaging. Baseline demographic and systemic parameters (age, sex, diabetes duration, treatment type, and HbA1c level) were recorded. Mean phacoemulsification time was documented during surgery.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eEligible participants included individuals with type 2 diabetes who had cataract resulting in a best-corrected visual acuity (BCVA) of 0.5 or less, and cataract graded at least N3 or P3 on the LOCS Ill scale.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eExclusion criteria were: severe cataract with dense nuclei that precluded preoperative OCT imaging; intraoperative complications such as posterior capsule rupture; proliferative diabetic retinopathy (with or without prior panretinal photocoagulation); preexisting subclinical central retinal thickening or diabetic macular edema; the presence of epiretinal membrane or vitreomacular traction; coexisting ocular diseases including glaucoma or uveitis; and any intraocular surgery performed within the preceding six months.\u003c/p\u003e\n\u003ch3\u003eDefinition of Clinically Significant Retinal Thickening\u003c/h3\u003e\n\u003cp\u003eChanges in CRT\u0026thinsp;\u0026lt;\u0026thinsp;10 \u0026micro;m was considered as an artefact or part of the normal fluctuation. A clinically significant worsening was defined as an increase in CRT\u0026thinsp;\u0026ge;\u0026thinsp;50 \u0026micro;m on OCT imaging compared to baseline values in both groups.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData was collected, stored, and managed in a spreadsheet using Microsoft Excel 2010\u0026reg; software. Data were analyzed and figures prepared using SPSS\u0026reg; version 23.0 (IBM Corp, Armonk, NY, USA).\u003c/p\u003e\u003cp\u003eDescriptive analysis was done where categorical variables were reported as frequencies and percentages and Chi-squared tests done to test the differences between the Group I and Group II. For the continuous variables, tests for normality were done using Shapiro-Wilk test and Q-Q plots; the data were not normally distributed and were reported as medians, interquartile range (IQR). Consequently, Kruskal-Wallis and Mann-Whitney were used to test the differences between the groups and Friedman and Wilcoxon tests used for within the groups\u0026rsquo; comparisons (applying Bonferroni correction where necessary).\u003c/p\u003e\u003cp\u003eAdditionally, Spearman\u0026rsquo;s correlation was used to correlate the CRT measurement at 6 weeks with duration of disease in years and HbA1c (%) levels.\u003c/p\u003e\u003cp\u003eAny output with a \u003cem\u003ep\u003c/em\u003e below 0.05 was interpreted as an indicator of statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 102 eyes from 102 patients were included in the study, with 51 eyes each in Group I (diabetic patients without DR) and Group II (diabetic patients with DR). Participant\u0026rsquo;s demographics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) were similar in both groups. Mean age was 65 years (IQR: 63\u0026ndash;69) in both groups. The median duration of disease was 11 years in both groups (IQR: 11\u0026ndash;12). Most patients were on oral antidiabetic drugs (OAD), 92.2% patients in Group I, and 84.3% patients in Group II. Insulin use was higher in Group II (15.7%), but the difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.357). The median HbA1c value was 6.9 (IQR: 6.5-7) in Group I and 6.9 (IQR: 6.5\u0026ndash;7.2) in Group II. No differences in the rest of baseline parameters were statistically significant.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics and baseline characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eALL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGROUP I\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGROUP II\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEyes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e---\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender, male: female (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.8:41.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.8:39.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.9:43.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.687\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (63\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (63\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (63\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.795\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of disease in years, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (11\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (11\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (11\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.146\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTherapy; insulin: OAD (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.8:88.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.8:92.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.7:84.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.357\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin A1c (%), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.9 (6.5-7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.9 (6.5-7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.9 (6.5\u0026ndash;7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.580\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage Phaco time, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.55 (0.48\u0026ndash;0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.55 (0.48\u0026ndash;0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.55 (0.48\u0026ndash;0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.957\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBCVA, decimal equivalent, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3 (0.3\u0026ndash;0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4 (0.3\u0026ndash;0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3 (0.3\u0026ndash;0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.358\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRT at baseline (\u0026micro;m) median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.666\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u0026yen;\u003c/sup\u003eChi-squared test; \u003csup\u003eα\u003c/sup\u003eMann-Whitney test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCRT was measured in micrometers (\u0026micro;m) at baseline, week 1, week 6, and week 12 postoperatively, in all patients (n\u0026thinsp;=\u0026thinsp;102), in Group I and in Group II.\u003c/p\u003e\u003cp\u003eWithin Group Analysis:\u003c/p\u003e\u003cp\u003eThe change in CRT (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was statistically significant in both groups separately compared to baseline. In week. 1 postoperatively, CRT remained unchanged. Comparing to the baseline, the biggest CRT changes was recorded in week 6 in both groups with median 263 \u0026micro;m (IQR:255\u0026ndash;269) in the Group 1 and 270 \u0026micro;m (IQR:260\u0026ndash;280) in Group II. CRT slowly decreased in week 12.\u003c/p\u003e\u003cp\u003eBetween Group Analysis:\u003c/p\u003e\u003cp\u003eComparing the CRT changes between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the difference was statistically significant in week 6 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and remained significant in week 12 (p\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCRT changes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eALL\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGROUP I\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGROUP II\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRT (\u0026micro;m) Baseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.666\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRT (\u0026micro;m) 1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.871\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRT (\u0026micro;m) 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e265 (255\u0026ndash;275)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e263 (255\u0026ndash;269)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e270 (260\u0026ndash;280)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRT (\u0026micro;m) 12 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260 (250\u0026ndash;269)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e259 (250\u0026ndash;265)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e260 (255\u0026ndash;270)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e \u003csup\u003e\u0026euro;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003csup\u003eα\u003c/sup\u003eMann-Whitney test; \u003csup\u003e\u0026euro;\u003c/sup\u003eFriedman test; *Statistically significant at 5% level of significance\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDuring the 6 weeks after the cataract surgery (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), CRT worsened\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026micro;m in 14 patients (27,5%) in Group I and in 38 patients (74,5%) in Group II with statistical significance p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. CRT worsened\u0026thinsp;\u0026ge;\u0026thinsp;29 \u0026micro;m in 11 patients (21,6%) in Group II with statistical significance p\u0026thinsp;=\u0026thinsp;0.001. 4 patients (7,8%) in Group II had clinically significant CRT increased\u0026thinsp;\u0026ge;\u0026thinsp;50 \u0026micro;m. Median BCVA loss was the same in both groups 0.6 (IQR: 0.6\u0026ndash;0.7) with no statistical significance p\u0026thinsp;=\u0026thinsp;0.265.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of results in Groups I and II in week 6\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup I\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGroup II\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e51\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10 \u0026micro;m\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.5% (14 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.5% (38 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;29 \u0026micro;m\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0% (0 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.6% (11 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50 \u0026micro;m\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0% (0 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.8% (4 eyes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.043*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBCVA loss (de), median (IQR) \u003csup\u003eα\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6 (0.6\u0026ndash;0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6 (0.6\u0026ndash;0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026yen;\u003c/sup\u003eChi-squared test; \u003csup\u003eα\u003c/sup\u003eMann-Whitney test; *Statistically significant at 5% level of significance\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRelations between duration of diabetes and HbA1C values with CRT changes in week 6 were tested (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients with longer duration of diabetes (r\u0026thinsp;=\u0026thinsp;0.201, p\u0026thinsp;=\u0026thinsp;0.042) and higher level of HbA1C (r\u0026thinsp;=\u0026thinsp;0.318, p\u0026thinsp;=\u0026thinsp;0.001) tend to have grater CRT values with statistically significant differences.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePatients in Group II (with non-proliferative diabetic retinopathy, NPDR) were further divided into three subgroups based on DR severity: mild, moderate, and severe (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). CRT increased progressively with DR severity, peaking in week 6 postoperatively. Patients with severe NPDR had the highest CRT values in both week 6 and 12, with statistically significant differences between the mild, moderate, and severe groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 at 6 weeks; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010 at 12 weeks).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCRT changes by Diabetic Retinopathy Severity (Group II)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSevere (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003cp\u003emedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003csup\u003e\u0026pound;\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOCT (\u0026micro;m) Baseline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e250 (243.75-256.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e255 (250\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.254\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOCT (\u0026micro;m) 1 week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255 (245\u0026ndash;260)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e252.5 (243.75-261.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e260 (250\u0026ndash;265)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.275\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOCT (\u0026micro;m) 6 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260 (255\u0026ndash;270)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e270 (260-282.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e285 (275\u0026ndash;300)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOCT (\u0026micro;m) 12 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260 (250-266.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e\u003cp\u003e260 (255-272.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e270 (266-278.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u0026pound;\u003c/sup\u003eKruskal-Wallis test; \u003csup\u003e\u0026euro;\u003c/sup\u003eFriedman test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe progression of median CRT after cataract surgery, stratified by diabetic retinopathy severity (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In contrast to severe NPDR, mild NPDR cases showed minimal CRT elevation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiabetes significantly increases the risk and progression of cataracts, making cataracts a major cause of visual impairment in diabetic patients. Although cataract surgery is effective, diabetic patients face higher complication rates compared to non-diabetics [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Cataract surgery increases the risk of retinopathy progression and postoperative macular edema in diabetic patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study investigated short-term changes in central retinal thickness (CRT) following uncomplicated cataract surgery in diabetic patients, with a specific focus on how varying stages of non-proliferative diabetic retinopathy (NPDR) influence retinal response. Diabetic patients without previous DR (Group I) show the CRT changes postoperatively with statistically significant from baseline (p \u0026lt; 0.001). 14 patients (27,5%) increase CRT ≥ 10µm in week 6. Several studies show that even diabetic patients without retinopathy have a higher risk of developing macular edema post operatively [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. British Retrospective Database (78,000 + eyes) was the large-scale retrospective cohort study which analyzed data from over 78,000 cataract surgeries in the United Kingdom to investigate the risk factors for developing postoperative macular edema. The key findings were that diabetic patients without any clinical signs of diabetic retinopathy still had a 1.8 times higher risk of developing macular edema after cataract surgery compared to non-diabetic patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn the other side, patients with preexisting DR had a higher risk to increasing CRT postoperatively (Group II). Compared to the diabetic patients without retinopathy (Group I) difference was statistically significant in week 6 (p \u0026lt; 0.001) and in week 12 (p \u0026lt; 0.006). 11 patients (21,6%) increased CRT ≥ 29µm and 4 patients (7,8%) increased CRT ≥ 50µm in Group II. Moreover, an increase of the CRT has previously been reported in diabetic eyes, which is similar to the results of our research [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChen et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and Chu et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] reported a higher risk macular edema in diabetic eyes, particularly in the presence of retinopathy. Our results further support the observation that the inflammatory and vascular responses in diabetic retinas are more pronounced due to a compromised blood-retinal barrier. Even though no patients in our cohort received prophylactic NSAID therapy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the incidence of macular edema in Group I remained low, give the importance of retinopathy stage as a critical risk factor.\u003c/p\u003e\u003cp\u003ePatients with severe NPDR demonstrated the highest CRT values, peaking at a median of 285 µm in week 6 and remaining elevated in week 12. By contrast, patients with mild or moderate NPDR showed smaller CRT increases, with partial resolution in month 3. These results are consistent with previous literature indicating that DR severity correlates with the degree of central retinal thickening [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study the central retinal thickness (CRT) increased peaking at 6 weeks after cataract surgery. Previous reports have also shown that the incidence of macular edema peaks approximately 4–6 weeks after uneventful cataract [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Despite increased CRT, no significant difference in BCVA loss mean was observed between patients with and without DR (p = 0.265). CRT changes (10 ≤ from baseline) led to no detectable BCVA reduction in the short term [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe also found that longer duration of diabetes (\u0026gt; 10 years) and HbA1c (\u0026gt; 5,9%), were independently associated with higher CRT in week 6. Our study confirmed the hypothesis about risk factors that can influence the CRT changes after the uncomplicated cataract surgery in diabetics, explained in the following studies.\u003c/p\u003e\u003cp\u003eYung J. et al. demonstrated the longer duration of diabetes and HbA1C\u003csub\u003ec\u003c/sub\u003e were risks for macular edema in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, Kanzlers P. et al. showed the preoperative HbA1c was independent risk factors for CRT increase 1 month after cataract surgery [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn the other side, Denier C. et al. did not find influence of glycemic control (measured by HbA1C) or duration of diabetes to postoperative increase of CRT which can be related to the low number of patients included in study [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be emphasized. Although the sample size was adequate to detect significant differences between groups, it remains relatively small and was conducted at a single center.\u003c/p\u003e\u003cp\u003eThe follow-up period was limited to 12 weeks, focusing only on short-term CRT changes. While this timeframe captures the typical peak period for postoperative macular thickening, it may not reflect long-term outcomes.\u003c/p\u003e\u003cp\u003eSystemic factors like HbA1c and diabetes duration were analyzed, other important variables such as lipid profile, renal function, hypertension[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], or inflammatory biomarkers were not included.\u003c/p\u003e\u003cp\u003eAdditionally, no prophylactic NSAIDs were administered as part of the study protocol. While this helped isolate the natural postoperative response, it does not reflect routine clinical practice where NSAIDs are often used to reduce the risk of macular edema.\u003c/p\u003e\u003cp\u003eAn increase in CRT often reflects accumulation of fluid in the retina, which may lead to macular edema—the most common cause of poor visual recovery after successful cataract surgery. According to the DRCR.net Cohort (2013) a real-world follow-up of diabetic eyes (without macular edema) undergoing cataract surgery reported a 4% incidence of central-involved edema, with elevated CRT measured by OCT identifying cases even before symptoms appear [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ediabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBRB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eblood retina barrier\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ediabetic retinopathy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecentral retinal thickness\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eoptical coherent tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehypertension\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLOCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elens opacite classification system\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eETRDS.\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eearly treatment diabetic retinopathy study\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBCVA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebest corrected visual acuity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNSAID\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003enonsteroidal anti-inflammatory drug\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHbA1c\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehemoglobin A1c\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOAD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eoral antidiabetic drug\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNPDR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003enon-proliferative diabetic retinopathy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was granted\u0026nbsp;by Institutional Ethics Committee of University Clinical Center of Republic of Srpska (No 01-19-238-2/22, date 13\u003csup\u003eth\u003c/sup\u003e of July 2022.) and conducted in accordance with the Declaration of Helsinki 1964.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grants from funding agencies in the public, commercial, or non-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSasa Smolianovic Skocic, Sanela-Sanja Burgic, Rakan M. Algorinees, and Shog K.\u003c/p\u003e\n\u003cp\u003eAlahmed contributed to the conception, design, data collection, analysis, and drafting of the manuscript. All authors critically reviewed the content, approved the final version for submission, and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants in accordance with the guidelines of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHenriques, J., Vaz-Pereira, S., Nascimento, J. \u0026amp; Rosa, P. C. Diabetic Eye Disease. \u003cem\u003eActa Med. Port\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e (1), 107\u0026ndash;113 (2015 Jan-Feb).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanozzo, G. et al. Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study. \u003cem\u003eEye (Lond)\u003c/em\u003e. \u003cb\u003e36\u003c/b\u003e, 1687\u0026ndash;1693 (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanozzo, G. et al. Prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy: the DIabetes and CATaract study. \u003cem\u003eEur. J. Ophthalmol.\u003c/em\u003e \u003cb\u003e30\u003c/b\u003e, 315\u0026ndash;320 (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan, L. K., Lin, S. S., Chan, F. \u0026amp; Ng, D. S. Optimizing treatment for diabetic macular edema during cataract surgery. \u003cem\u003eFront Endocrinol. (Lausanne)\u003c/em\u003e Jan 25. (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaursen, S. B., Erichsen, J. H., Holm, L. M. \u0026amp; Kessel, L. Prevention of macular edema in patients with diabetes after cataract surgery. \u003cem\u003eJ. Cataract Refract. Surg.\u003c/em\u003e \u003cb\u003e45\u003c/b\u003e (6), 854\u0026ndash;869 (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamadi, B. et al. Antiinflammatory treatment after cataract surgery in Sweden: changes in prescribing patterns from 2010 to 2017. \u003cem\u003eBMJ Open. Ophthalmol.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e (1), e000635 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChu, C. J. et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81,984 eyes. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e123\u003c/b\u003e, 316\u0026ndash;323 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeppieri, M. et al. Optical coherence tomography (OCT): a brief look at the uses and technological evolution of ophthalmology. \u003cem\u003eMed. (Kaunas)\u003c/em\u003e. \u003cb\u003e59\u003c/b\u003e (12), 2114 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlQahtani, A. S. et al. Saudi Arabia guidelines for diabetic macular edema: a consensus of the Saudi Retina Group. \u003cem\u003eSaudi Med. J.\u003c/em\u003e \u003cb\u003e42\u003c/b\u003e (2), 131\u0026ndash;145 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePollreisz, A. \u0026amp; SchmidtErfurth, U. Diabetic cataract\u0026mdash;pathogenesis, epidemiology and treatment. \u003cem\u003eJ. Ophthalmol.\u003c/em\u003e \u003cb\u003e2010\u003c/b\u003e, 608751 (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim, S. J., Equi, R. \u0026amp; Bressler, N. M. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e114\u003c/b\u003e (5), 881\u0026ndash;889 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiabetic Retinopathy Clinical Research Network et al. Macular edema after cataract surgery in eyes without preoperative centralinvolved diabetic macular edema. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e120\u003c/b\u003e (9), 2004\u0026ndash;2011 (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, X. Y., Song, W. J., Cai, H. Y. \u0026amp; Zhao, L. Macular edema after cataract surgery in diabetic eyes evaluated by optical coherence tomography. \u003cem\u003eInt. J. Ophthalmol.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e (1), 81\u0026ndash;85 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYao, H., Yang, Z., Cheng, Y. \u0026amp; Shen, X. Macular changes following cataract surgery in eyes with early diabetic retinopathy: an OCT and OCT angiography study. \u003cem\u003eFront. Med. (Lausanne)\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e, 1290599 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuliani, B. P., Agarwal, I. \u0026amp; Naik, M. P. Effect of uncomplicated cataract surgery on central macular thickness in diabetic and nondiabetic subjects. \u003cem\u003eJ. Ophthalmic Vis. Res.\u003c/em\u003e \u003cb\u003e14\u003c/b\u003e (4), 442\u0026ndash;447 (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkkaya, S. \u0026amp; Ozkurt, Y. Changes in central macular thickness after uncomplicated phacoemulsification surgery in diabetic and nondiabetic patients. \u003cem\u003eBeyoglu Eye J.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (1), 13\u0026ndash;19 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParuchuri, S. S., Mahmoudzadeh, R., Wheeler, S. \u0026amp; Randolph, J. Prevention and management of postcataract cystoid macular edema. \u003cem\u003eCurr. Opin. Ophthalmol.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (3), 182\u0026ndash;188 (2025).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJamaiyar, A., Kumar, S., Kiran, N., Mahato, R. K. \u0026amp; Anand, M. A prospective study to evaluate changes in macular thickness after uncomplicated cataract surgery using optical coherence tomography in diabetic patients. \u003cem\u003eInt. J. Res. Med. Sci.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (8), 2832\u0026ndash;2836 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZareiGhanavati, S., Hadi, Y., Habibi, A., Ashraf Khorasani, M. \u0026amp; Yoo, S. H. Cataract and diabetes: review of the literature. \u003cem\u003eJ. Cataract Refract. Surg.\u003c/em\u003e \u003cb\u003e50\u003c/b\u003e (12), 1275\u0026ndash;1283 (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerente, I. et al. Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography. \u003cem\u003eCurr. Eye Res.\u003c/em\u003e \u003cb\u003e32\u003c/b\u003e (3), 241\u0026ndash;247 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarolo, P. et al. Retinal thickness deviation: a new OCT parameter for assessing diabetic macular edema. \u003cem\u003eJ. Clin. Med.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (12), 3976 (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiabetic Retinopathy Clinical Research Network et al. Relationship between optical coherence tomographymeasured central retinal thickness and visual acuity in diabetic macular edema. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e114\u003c/b\u003e (3), 525\u0026ndash;536 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWiley, H. E. \u0026amp; Frederick, L. Nonproliferative diabetic retinopathy and diabetic macular edema. In: \u003cem\u003eRetina\u003c/em\u003e (Fifth Edition). Philadelphia: W.B. Saunders; 940\u0026ndash;968. (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang, J. et al. Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients. \u003cem\u003eJ. Cataract Refract. Surg.\u003c/em\u003e \u003cb\u003e43\u003c/b\u003e (2), 207\u0026ndash;214 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKanclerz, P., Hecht, I. \u0026amp; Tuuminen, R. Preoperative macular thickness in patients with diabetes correlates with macular changes after cataract surgery. \u003cem\u003eGraefes Arch. Clin. Exp. Ophthalmol.\u003c/em\u003e \u003cb\u003e259\u003c/b\u003e (6), 1679\u0026ndash;1680 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDenier, C., Fajnkuchen, F. \u0026amp; GiocantiAur\u0026eacute;gan, A. Central retinal thickness assessment in a reallife setting after cataract surgery in diabetic patients. \u003cem\u003eJ. Fr. Ophtalmol\u003c/em\u003e. \u003cb\u003e41\u003c/b\u003e (10), 904\u0026ndash;909 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHiran, H. M. et al. Association of serum lipid profile and other systemic risk factors with retinal hard exudates in diabetic retinopathy. \u003cem\u003eInt. Ophthalmol.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 338 (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiabetic Retinopathy Clinical Research Network. Risk factors for development of macular edema after cataract surgery in eyes without preoperative macular edema. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cb\u003e120\u003c/b\u003e (9), 1843\u0026ndash;1851 (2013).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cataract surgery, diabetic retinopathy, central retinal thickness, optical coherence tomography","lastPublishedDoi":"10.21203/rs.3.rs-7399330/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7399330/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo evaluate short-term changes in central retinal thickness (CRT) after uncomplicated cataract surgery in diabetic patients and assess the influence of diabetic retinopathy severity on postoperative retinal response.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis prospective, observational study included 102 eyes of 102 type 2 diabetic patients undergoing cataract surgery at a single tertiary center. Patients were divided into two groups: Group I (n\u0026thinsp;=\u0026thinsp;51) without diabetic retinopathy and Group II (n\u0026thinsp;=\u0026thinsp;51) with diabetic retinopathy. CRT was assessed using spectral-domain optical coherence tomography (SD-OCT) at baseline and postoperatively at weeks 1, 6, and 12. Changes in CRT\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026micro;m, \u0026ge;\u0026thinsp;29 \u0026micro;m, and \u0026ge;\u0026thinsp;50 \u0026micro;m were analyzed. Associations with systemic parameters such as duration of diabetes and HbA1c were also evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCRT significantly increased from baseline in both groups, peaking at 6 weeks postoperatively (Group I: median 263 \u0026micro;m; Group II: median 270 \u0026micro;m; p\u0026thinsp;=\u0026thinsp;0.001). At 6 weeks, 27.5% of Group I and 74.5% of Group II patients developed CRT increases\u0026thinsp;\u0026ge;\u0026thinsp;10 \u0026micro;m (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 21.6% of Group II showing increases\u0026thinsp;\u0026ge;\u0026thinsp;29 \u0026micro;m and 7.8% \u0026ge;50 \u0026micro;m. No significant differences in best corrected visual acuity (BCVA) loss were observed between groups (p\u0026thinsp;=\u0026thinsp;0.265). Among Group II, CRT elevation was greatest in patients with more severe stage of diabetic retinopathy. Higher HbA1c and longer diabetes duration correlated positively with CRT increase at week 6 (r\u0026thinsp;=\u0026thinsp;0.318 and r\u0026thinsp;=\u0026thinsp;0.201, respectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSubclinical CRT changes were observed after the cataract surgery in diabetic patients, particularly in those with existing diabetic retinopathy (DR). The severity of DR correlates with the magnitude of retinal thickening, peaking at 6 weeks. Despite CRT elevation, visual acuity remained stable in the short term. Duration of diabetes and elevated HbA1c were identified as systemic risk factors. These findings underscore the importance of OCT monitoring and DR staging in perioperative diabetic care.\u003c/p\u003e","manuscriptTitle":"Impact of Uncomplicated Cataract Surgery on Central Retinal Thickness Changes in Diabetic Patients - Short-Term Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 13:06:07","doi":"10.21203/rs.3.rs-7399330/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e76c9e11-4a99-430a-a592-67b02b6e59a6","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55068517,"name":"Health sciences/Diseases"},{"id":55068518,"name":"Health sciences/Endocrinology"},{"id":55068519,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-10-08T16:39:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 13:06:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7399330","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7399330","identity":"rs-7399330","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}