Risk factors for pupil changes in patients with diabetic retinopathy and cataract after phacoemulsification with intraocular lens implantation

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BACKGROUND: This study aims to identify the risk factors associated with pupillary changes in patients with diabetic retinopathy (DR) and cataract undergoing phacoemulsification with intraocular lens implantation (PHACO + IOL). METHODS: This retrospective observational study included patients with DR and cataract who underwent phacoemulsification and intraocular lens implantation between February 2021 and August 2023. Patients were categorized into two groups based on the presence or absence of pupillary changes following surgery. RESULTS: A total of 162 patients were analyzed, with pupillary changes occurring in 33 cases (20.37%). Multivariate logistic regression analysis revealed that a longer duration of diabetes (OR = 2.73; 95% CI: 1.02-7.27, P = 0.045), higher lens nucleus grade (OR = 3.95; 95% CI: 1.58-9.89, P = 0.003), greater severity of DR (OR = 3.60; 95% CI: 1.40-9.28, P = 0.008), and intraoperative posterior lens capsule rupture (OR = 6.41; 95% CI: 1.75-23.47, P = 0.005) were significant risk factors for postoperative pupillary changes in DR patients undergoing PHACO + IOL. CONCLUSION: Phacoemulsification with intraocular lens implantation is an effective treatment for patients with DR and cataract. However, factors such as the duration of diabetes, severity of DR, and intraoperative complications are associated with an increased risk of pupillary changes. Therefore, rigorous blood glucose control, adherence to standardized surgical protocols, and preventive care are recommended to optimize patient outcomes. TRIAL REGISTRATION: Not applicable. CLINICAL TRIAL NUMBER: Not applicable.

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