Hussain Zain S, Shakarchi Ahmed F, Chauhan Muhammad Z, Jester Dane A, Soliman Mohamed K, Sallam Ahmed B
From the Department of Ophthalmology (Z.H., A.S., M.C., D.J., A.S.), Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
University Hospitals Eye Institute (M.S.), Case Western Reserve University, Cleveland, Ohio, USA; Department of Ophthalmology (M.S.), Assiut University Hospitals, Assiut, Egypt.
Am J Ophthalmol. 2025 Sep;277:17-25. doi: 10.1016/j.ajo.2025.04.033. Epub 2025 May 3.
To assess the relationship between cataract surgery and the 30-day incidence of post-operative endophthalmitis (POE) (analysis 1) and serious systemic adverse events (analysis 2) in diabetic patients with varying preoperative hemoglobin A1c (HbA1c) levels.
Retrospective, longitudinal cohort study; multicenter study using a global federated database of electronic health records.
Adults (≥18 years) with type 1 or type 2 diabetes mellitus who underwent phacoemulsification cataract surgery. Control groups in analysis 1 were patients without diabetes who underwent cataract surgery. Control groups in analysis 2 were diabetic patients with similar HbA1c who had a routine eye examination without cataract surgery.
Cataract surgery.
The primary outcomes were 30-day incidence of: (1) POE, defined by ICD-10 codes; and (2) serious systemic adverse events, including mortality, stroke/transient ischemic attack, major cardiovascular events, and a composite outcome of these events. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards models.
In analysis 1, the risk of POE within 30 days post-cataract surgery did not differ significantly across HbA1c levels compared to non-diabetic controls. The HRs were 0.62 (95% CI, 0.30-1.27) for good HbA1c level (<7%), 1.08 (95% CI, 0.44-2.66) for moderate (7%-8.4%), 1.36 (95% CI, 0.43-4.28) for poor (8.5%-11.3%), and 2.85 (95% CI, 0.29-27.44) for very poor HbA1c (>11.3%). In analysis 2, the HRs for the 30-day composite outcome of any systemic events were not significantly different across HbA1c levels compared to controls. The 90-day analyses showed similar results for systemic events.
Cataract surgery does not appear to increase the risk of POE or serious systemic adverse events in diabetic patients across all HbA1c levels. These findings suggest that HbA1c alone should not be a reason to defer cataract surgery and highlight the need for individualized risk assessments to determine surgical fitness.
评估不同术前糖化血红蛋白（HbA1c）水平的糖尿病患者白内障手术与术后30天内发生术后眼内炎（POE）（分析1）及严重全身性不良事件（分析2）之间的关系。
回顾性纵向队列研究；使用全球联合电子健康记录数据库的多中心研究。
接受超声乳化白内障手术的1型或2型糖尿病成年患者（≥18岁）。分析1中的对照组为接受白内障手术的非糖尿病患者。分析2中的对照组为HbA1c水平相似且接受常规眼科检查但未进行白内障手术的糖尿病患者。
白内障手术。
主要结局为30天内发生以下情况的发生率：（1）根据国际疾病分类第10版（ICD-10）编码定义的POE；（2）严重全身性不良事件，包括死亡率、中风/短暂性脑缺血发作、重大心血管事件以及这些事件的综合结局。使用Cox比例风险模型计算风险比（HR）和95%置信区间（CI）。
在分析1中，与非糖尿病对照组相比，白内障手术后30天内POE风险在不同HbA1c水平之间无显著差异。HbA1c水平良好（<7%）者的HR为0.62（95%CI，0.30 - 1.27），中等水平（7% - 8.4%）者为1.08（95%CI，0.44 - 2.66），较差水平（8.5% - 11.3%）者为1.36（95%CI，0.43 - 4.28），极差水平（>11.3%）者为2.85（95%CI，0.29 - 27.44）。在分析2中，与对照组相比，不同HbA1c水平下30天任何全身性事件综合结局的HR无显著差异。90天分析显示全身性事件的结果相似。
白内障手术似乎不会增加所有HbA1c水平糖尿病患者发生POE或严重全身性不良事件的风险。这些发现表明，仅HbA1c水平不应成为推迟白内障手术的理由，并强调需要进行个体化风险评估以确定手术适宜性。
