Patients with diabetes who undergo phacoemulsification cataract surgery are likely to experience more than double the rate of diabetic retinopathy progression than patients who do not undergo cataract surgery, according to a study in the August 1 edition of Ophthalmology.

The authors monitored 169 patients age 65 years or older with either type 1 or 2 diabetes for 12 months after undergoing phacoemulsification (278 operated eyes and 60 non-operated eyes).

Following surgery, they took digital fundus photographs of the patients’ retinas at one-, six- and 12-month intervals. At 12-month follow-up, 28.2% of the eyes that were operated on developed DR, compared to 13.8% of non-operated eyes.

While the findings indicate that phacoemulsification exacerbates disease progression, the authors suggest that patients who require cataract surgery may simply demonstrate a higher risk for DR. “One possibility that this study cannot easily address is the concern that both DR and cataract are complications of diabetes, and therefore, the presence of cataract may be a marker for greater severity or increased likelihood of progression of DR,” says lead author Jie Jin Wang, M.Med., Ph.D. “Although these findings should not argue against performing cataract surgery in older people with diabetes, it is important for clinicians to recognize this residual risk and to take appropriate precautions.”

Hong T, Mitchell P, de Loryn T, et al. Development and progression of diabetic retinopathy 12 months after phacoemulsification cataract surgery. Ophthalmology. 2009 Aug;116(8):1510-4.