Diabetes and diabetic retinopathy in patients undergoing cataract surgery: a prevalence study—DiCat study report #2



To report on the prevalence of diabetes, diabetic macula oedema (DME) and retinopathy and their respective grading in a large cohort of patients undergoing cataract surgery.


Data on previous diagnosis of diabetes, fasting glucose, glycated haemoglobin, presence and type of retinopathy and other maculopathy of 3657 patients over 55 years of age undergoing cataract surgery in 13 centres scattered throughout Italy were analysed.


A total of 20.4% of patients were known diabetics and 27.9% of diabetics showed signs of retinopathy. Haemoglobin A1C was higher than 48 mmol/L (6.5%) in 32% of diabetics and 2.4% non-diabetics. Fasting blood glucose level was higher than 120 mg/dL in 4.3% non-diabetics and 50% diabetics. Duration of diabetes did not significantly correlate with either fasting glucose or glycated haemoglobin, while higher grades of diabetic retinopathy were significantly more prevalent as duration of disease increased. DME was present in almost 40% of diabetics and 22% of patients showed non-diabetic maculopathy.


Diabetic retinopathy and DME worsen after cataract extraction thus complicating long-term prognosis and requiring expensive injective therapy. Since unknown diabetics represent 2–4% of the many million cataract candidates and even known diabetics show poor metabolic control and high rates of DME, preoperative medical testing and accurate retinopathy screening may prove both ethically necessary and cost-effective.

This is a preview of subscription content, access via your institution.


  1. 1.

    Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053

    Article  Google Scholar 

  2. 2.

    Bourne RR, Stevens GA, White RA et al (2013) Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health 1(6):e339–e349

    Article  Google Scholar 

  3. 3.

    Vieira-Potter VJ, Karamichos D, Lee DJ (2016) Ocular complications of diabetes and therapeutic approaches. Biomed Res Int 2016:3801570

    Article  Google Scholar 

  4. 4.

    Yau JW, Rogers SL, Kawasaki R et al (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35(3):556–644

    Article  Google Scholar 

  5. 5.

    Erie JC (2014) Rising cataract surgery rates: demand and supply. Ophthalmology 121(1):2–4. https://doi.org/10.1016/j.ophtha.2013.10.002

    Article  PubMed  Google Scholar 

  6. 6.

    Li L, Wan XH, Zhao GH (2014) Meta-analysis of the risk of cataract in type 2 diabetes. BMC Ophthalmol 24(14):94. https://doi.org/10.1186/1471-2415-14-94

    Article  Google Scholar 

  7. 7.

    Peterson SR, Silva PA, Murtha TJ, Sun JK (2018) Cataract surgery in patients with diabetes: management strategies. Semin Ophthalmol 33(1):75–82. https://doi.org/10.1080/08820538.2017.1353817

    Article  PubMed  Google Scholar 

  8. 8.

    Panozzo G, Staurenghi G, Dalla Mura G et al (2019) Prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy: The DIabetes and CATaract study. Eur J Ophthalmol. https://doi.org/10.1177/1120672119830578

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Shaw JE, Sicree RA, Zimmet PZ (2010) Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 87(1):4–14. https://doi.org/10.1016/j.diabres.2009.10.007

    CAS  Article  Google Scholar 

  10. 10.

    Tamayo T, Rosenbauer J, Wild SH et al (2014) Diabetes in Europe: an update. Diabetes Res Clin Pract 103(2):206–217. https://doi.org/10.1016/j.diabres

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Srinivasan S, Raman R, Swaminathan G, Ganesan S, Kulothungan V, Sharma T (2017) Incidence, progression, and risk factors for cataract in type 2 diabetes. Invest Ophthalmol Vis Sci 58(13):5921–5929

    CAS  Article  Google Scholar 

  12. 12.

    Chung J, Kim MY, Kim HS, Yoo JS, Lee YC (2002) Effect of cataract surgery on the progression of diabetic retinopathy. J Cataract Refract Surg 28(4):626–630

    Article  Google Scholar 

  13. 13.

    Diabetic Retinopathy Clinical Research Network Authors/Writing Committee, Baker CW, Almukhtar T et al (2013) Macular edema after cataract surgery in eyes without preoperative central-involved diabetic macular edema. JAMA Ophthalmol 131(7):870–879. https://doi.org/10.1001/jamaophthalmol.2013.2313

    Article  Google Scholar 

  14. 14.

    Diabetic Retinopathy Clinical Research Network Authors/Writing Committee, Bressler SB, Baker CW et al (2014) Pilot study of individuals with diabetic macular edema undergoing cataract surgery. JAMA Ophthalmol. 132(2):224–226. https://doi.org/10.1001/jamaophthalmol.2013.6209

    Article  Google Scholar 

  15. 15.

    Denniston AK, Chakravarthy U, Zhu H et al (2017) The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema. Br J Ophthalmol 101(12):1673–1678. https://doi.org/10.1136/bjophthalmol-2016-309838

    Article  PubMed  Google Scholar 

  16. 16.

    Keay L, Lindsley K, Tielsch J, Katz J, Schein O (2012) Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd007293.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Keay L, Lindsley K, Tielsch J, Katz J, Schein O (2019) Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev 1:CD007293. https://doi.org/10.1002/14651858.cd007293

    Article  PubMed  Google Scholar 

  18. 18.

    Vujosevic S, Toma C, Villani E et al (2019) Diabetic macular edema with neuroretinal detachment: OCT and OCT-angiography biomarkers of treatment response to anti-VEGF and steroids. Acta Diabetol. https://doi.org/10.1007/s00592-019-01424-4

    Article  PubMed  Google Scholar 

  19. 19.

    Busch C, Fraser-Bell S, Zur D et al (2019) Real-world outcomes of observation and treatment in diabetic macular edema with very good visual acuity: the OBTAIN study. Acta Diabetol 56(7):777–784. https://doi.org/10.1007/s00592-019-01310-z

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R (2016) Diabetic macular edema pathophysiology: vasogenic versus inflammatory. J Diabetes Res 2016:2156273

    Article  Google Scholar 

  21. 21.

    Querques L, Parravano M, Sacconi R, Rabiolo A, Bandello F, Querques G (2017) Ischemic index changes in diabetic retinopathy after intravitreal dexamethasone implant using ultra-widefield fluorescein angiography: a pilot study. Acta Diabetol 54(8):769–773. https://doi.org/10.1007/s00592-017-1010-1

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Panozzo GA, Gusson E, Panozzo G, Dalla Mura G (2017) Dexamethasone intravitreal implant at the time of cataract surgery in eyes with diabetic macular edema. Eur J Ophthalmol 27(4):433–437

    Article  Google Scholar 

  23. 23.

    Jung YH, Lee Y (2019) Efficacy of vitrectomy combined with an intraoperative dexamethasone implant in refractory diabetic macular edema. Acta Diabetol 56(6):691–696. https://doi.org/10.1007/s00592-019-01305-w

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Nunome T, Sugimoto M, Kondo M, Suto C (2018) Short-term results of intravitreal triamcinolone acetonide combined with cataract surgery for diabetic macular edema in Japan: in the era of anti-vascular endothelial growth factor therapy. Ophthalmologica 240(2):73–80. https://doi.org/10.1159/000487548

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Semeraro F, Russo A, Gambicorti E et al (2015) Efficacy and vitreous levels of topical NSAIDs. Expert Opin Drug Deliv 12:1767–1782

    CAS  Article  Google Scholar 

  26. 26.

    Singh RP, Lehmann R, Martel J et al (2017) Nepafenac 0.3% after cataract surgery in patients with diabetic retinopathy: results of 2 randomized phase 3 studies. Ophthalmology 124:776–785

    Article  Google Scholar 

  27. 27.

    Casparis H, Lindsley K, Kuo IC, Sikder S, Bressler NM (2017) Surgery for cataracts in people with age-related macular degeneration. Cochrane Database Syst Rev. 2:CD006757. https://doi.org/10.1002/14651858.cd006757

    Article  PubMed  Google Scholar 

  28. 28.

    Falcão MS, Freitas-Costa P, Beato JN et al (2017) Safety and effectiveness of cataract surgery with simultaneous intravitreal anti-VEGF in patients with previously treated exudative age-related macular degeneration. Acta Med Port 30(2):127–133. https://doi.org/10.20344/amp.7850

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Tommaso Rossi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard Statement

The study followed the tenets of Helsinki Declaration and consent was obtained.

Informed consent

All patients were informed of the purpose of study and signed a consent form.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article belongs to the topical collection Eye Complications of Diabetes managed by Giuseppe Querques.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLS 1106 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rossi, T., Panozzo, G., Della Mura, G. et al. Diabetes and diabetic retinopathy in patients undergoing cataract surgery: a prevalence study—DiCat study report #2. Acta Diabetol 57, 645–650 (2020). https://doi.org/10.1007/s00592-019-01466-8

Download citation


  • Diabetic retinopathy
  • Macular oedema
  • Cataract surgery