Diabetic patients develop cataracts earlier and more rapidly than the general population. When cataract surgery is needed in a patient with concurrent diabetic retinopathy, the approach differs meaningfully from standard phacoemulsification. Planning cataract surgery in this setting requires retinal assessment before the operation, a decision on staging versus combining procedures, and close post-operative surveillance for retinopathy progression.

According to Dr. Mayank Bansal, a leading cataract and retina surgeon at the Best Eye Hospital in Delhi,
“In a diabetic patient, the cataract and the retina are never independent problems. Removing the lens without addressing the retinal status first often leads to worse vision outcomes than the cataract itself.”

What Precautions Must Be Taken Before and During Surgery?

Pre-operative preparation in diabetic cataract patients goes beyond routine biometry. The retinal status, glycaemic control, and surgical timing all require specific assessment.

• Retinal evaluation before surgery: Dilated fundus examination and OCT must be performed before cataract surgery in every diabetic patient.
• Glycaemic optimisation: HbA1c above 8.5 percent at the time of surgery is associated with slower wound healing, increased post-operative inflammation, and faster retinopathy progression. 
• Retinopathy staging and treatment sequencing: Mild to moderate non-proliferative DR without macular edema can proceed to cataract surgery first with close retinal follow-up.
• Surgical technique modifications: Minimising surgical time, using lower phacoemulsification energy, avoiding iris trauma, and achieving a watertight wound all reduce post-operative inflammation in the diabetic eye.
• Pupil dilation: Diabetic patients commonly have poorly dilating pupils due to iris ischaemia and posterior synechiae.

The sequence of interventions matters as much as the quality of each individual procedure. For the full range of cataract surgery options and IOL types available at Claritas.

When Is a Combined Cataract and Retinal Procedure Appropriate?

In selected patients, combining cataract extraction with retinal surgery in a single anaesthetic episode offers clear advantages over staging the two procedures separately.

• Combined phaco-vitrectomy: When the cataract prevents adequate retinal assessment or treatment, combining phacoemulsification with pars plana vitrectomy in a single session allows the surgeon to remove the cataract. 
• IOL choice in combined cases: In combined phaco-vitrectomy, the capsular bag is preserved and a standard IOL is implanted.
• Post-operative surveillance after combined surgery: Anti-VEGF injections are often continued post-operatively for macular edema management. 
• When staging is still preferable: In patients with mild to moderate NPDR and no macular edema, staging cataract surgery first and reviewing the retina at one and three months post-operatively is appropriate. 

Surgery-induced inflammation is manageable and the risk of significant retinopathy acceleration is low in this subgroup.

Why Choose Claritas Eye Hospital for Cataract Surgery?

Dr. Mayank Bansal is MD (AIIMS), FRCS (Glasgow), FACS, with subspecialty training in both cataract surgery and vitreoretinal surgery at AIIMS and UCLA. Over 15 years managing complex diabetic eye disease including combined phaco-vitrectomy, panretinal photocoagulation, and intravitreal injection protocols across all stages of diabetic retinopathy.