Intraocular Pressure after Uneventful Phacoemulsification in Diabetic and Nondiabetic Patients: A Prospective...

Phacoemulsification cataract surgery, the standard treatment for visually significant cataracts, has been shown to influence intraocular pressure (IOP); however, the extent and underlying mechanisms of this effect may differ in patients with systemic conditions such as diabetes mellitus. Although some evidence exists, studies have reported conflicting results regarding whether diabetic and nondiabetic patients exhibit differences in postoperative IOP changes following phacoemulsification. Therefore, this study aimed to evaluate and compare postoperative IOP alterations in diabetic and nondiabetic patients.

A prospective observational study was conducted among 208 adults aged ≥50 years with cataract, including 104 diabetic and 104 nondiabetic patients. The study adhered to STROBE guidelines. IOP was measured preoperatively and at 1 and 6 weeks postoperatively using Goldmann applanation tonometry. Data normality was assessed with the Shapiro-Wilk test, sphericity with Mauchly's test, and variance homogeneity with Levene's test. Repeated measures ANOVA evaluated changes in IOP over time and between groups, including time × group interactions, while linear mixed-effects modeling accounted for repeated measurements and estimated the magnitude of postoperative IOP changes. A p-value < 0.05 was considered statistically significant.

Repeated measures ANOVA showed significant effects of time (F = 610.5, p = 0.003), diabetes (F = 32.1, p = 0.041), and the time × diabetes interaction (F = 55.2, p = 0.002), indicating IOP decreased over time in all patients, with greater reductions in nondiabetics. Linear mixed-effects modeling confirmed significant postoperative IOP decreases: nondiabetic patients showed reductions of 1.2 mm Hg at 1 week (β = -1.20, 95% CI:-1.88 to -0.52) and 2.5 mm Hg at 6 weeks (β =-2.50, 95% CI:-3.34 to -1.66), whereas diabetic patients had smaller reductions (1 week × diabetes: β = 0.90, 95% CI: 0.16-1.64; 6 weeks × diabetes: β = 1.75, 95% CI: 0.97-2.53). Among diabetics, higher HbA1c (β = 1.70, 95% CI: 0.82-2.58) and diabetes duration (β = 1.30, 95% CI: 0.56-2.04) were significantly associated with change in postoperative IOP.

Phacoemulsification effectively lowers IOP in older adults with cataract; however, the reduction is smaller in diabetic patients and is influenced by HbA1c levels and diabetes duration. Careful postoperative monitoring of IOP is recommended in diabetic individuals. A randomized controlled trial is recommended to further investigate these differences and the impact of glycemic control on postoperative IOP outcomes.

Papadopoulos Z. Intraocular Pressure after Uneventful Phacoemulsification in Diabetic and Nondiabetic Patients: A Prospective Observational Study. J Curr Glaucoma Pract 2026;20(1):4-10.