Effects of Intraoperative Anti-VEGF Injection Combined With Microincision Phacoemulsification on Visual Recovery and Diabetic Retinopathy Progression in Patients With Cataract: A Prospective Comparative Study

Background:Cataract and diabetic retinopathy (DR) are common diabetic ocular complications.This study aimed to evaluate whether coaxial microincision cataract phacoemulsification (C-MICS) combined with intraoperative intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection could improve visual recovery, reduce central retinal thickness, and lower DR progression in patients with cataract and DR. Material/Methods:A total of 120 cataract patients with non-proliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR) were enrolled in this prospective study.Both groups underwent C-MICS, while the combined-treatment group additionally received a single intraoperative intravitreal anti-VEGF injection.Outcomes included best corrected visual acuity (BCVA), central retinal thickness (CRT), DR progression, complications, anterior chamber inflammation, and glycosylated hemoglobin A1c (HbA1c).Multivariate logistic regression analysis was used to identify factors associated with DR progression. Results:The combined-treatment group showed better postoperative BCVA from week 1 to month 12 (all P < 0.05) and greater CRT reduction from month 1 to month 12 (all P < 0.05).At 12 months, DR progression was lower in the combined-treatment group than in the phacoemulsification-alone group (10.0%vs 26.7%, P = 0.023).Postoperative flare scores did not differ significantly between groups (all P > 0.05).Multivariate logistic regression showed that intraoperative anti-VEGF injection was associated with reduced DR progression (odds ratio [OR] = 0.29, 95% CI: 0.10-0.83,P = 0.021), whereas higher HbA1c was associated with increased DR progression (OR = 1.42, 95% CI: 1.01-2.00,P = 0.045). Conclusions:In cataract patients with NPDR or early PDR, combined treatment was associated with better visual recovery, greater CRT reduction, and lower 12-month DR progression without increased safety concerns.