Patients with diabetes are more likely to experience post-operative endophthalmitis (POE) and posterior capsule rupture (PCR) with cataract surgery, a new study has found.
POE, a rare but severe complication of cataract surgery, is approximately 17% more likely in patients with diabetes, while PCR during surgery is more than three times as likely, according to the systematic review and meta-analysis, published in the Journal of Ophthalmic Inflammation and Infection.1
The data also linked significantly lower POE risk, with or without diabetes, to the use of postoperative intracameral and topical antibiotics.
The incidence of POE has been reported in our study as significantly higher in people with diabetes compared to those without diabetes…
Recognised Risk
The study authors said PCR is a known risk factor for POE and is observed at a higher rate in people with diabetes.
“The increased PCR risk in people with diabetes may be attributed to factors such as altered lens anatomy and the greater prevalence of comorbidities that complicate surgery,” they said.
They also noted that diabetes mellitus is a recognised risk factor for POE due to its association with delayed wound healing, heightened inflammatory responses, and compromised immunity.
People with diabetes often have coexisting conditions such as hypertension and diabetic retinopathy, further increasing their susceptibility to post-surgical complications. As well, poor blood sugar control and insulin use have been associated with an increased infection risk, possibly due to impaired immune function and delayed healing.
“Despite these concerns, the relationship between diabetes, blood sugar control, and POE following cataract surgery remains unclear,” they said.
“The incidence of POE has been reported in our study as significantly higher in people with diabetes compared to those without diabetes… while the pathophysiological mechanisms underlying this increased susceptibility remain unclear, it is hypothesised that people with diabetes-altered immune response, and impaired wound healing, may contribute to the elevated risk.
“Our meta-analysis shows that people with diabetes have a significantly higher incidence of POE and PCR following cataract surgery compared to those without diabetes. Specifically, the odds ratio for POE is 1.174, indicating a 17.4% increased risk in people with diabetes. For PCR, the incidence rate is 0.214 for people with diabetes versus 0.158 for those without, with an odds ratio of 3.434, reflecting more than a threefold increased risk of PCR in people with diabetes compared to those without diabetes.
“Antibiotic use has a significant protective effect for both groups, reducing the incidence of POE in those receiving prophylaxis.
“Our findings highlight the need for tailored risk assessment in people with diabetes undergoing cataract surgery to minimise the likelihood of postoperative infections and improve outcomes.”
The study authors concluded that it was crucial to maintain well-controlled blood sugar and blood pressure before surgery, and that during surgery, extra caution should be taken to prevent PCR, and appropriate antibiotic use should be considered to minimise the risk of POE.
Reference
- Chen KY, Chan HC, Chan CM. Do people with diabetes have a higher risk of developing postoperative endophthalmitis after cataract surgery? A systematic review and meta-analysis. J Ophthal Inflamm Infect. 2025;15(24). doi: 10.1186/s12348-025-00483-9.
