Association between preoperative lipid profile and early postoperative objective optical quality after cataract surgery

Objective This study examined the association between preoperative lipid levels and early postoperative objective visual quality after cataract surgery. Methods This retrospective study included patients who underwent phacoemulsification with implantation of the same monofocal intraocular lens (IOL) model between November 2024 and May 2025. Preoperative serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were recorded. Patients were grouped according to guideline-based lipid criteria. Objective visual quality was evaluated at postoperative day 1, week 1, and month 1 using the iTrace aberrometer and OQAS II system. Outcomes included best-corrected visual acuity (BCVA), dysfunctional lens index (DLI), objective scatter index (OSI), higher-order aberrations (HOAs), modulation transfer function (MTF), and Strehl ratio (SR). Between-group comparisons, Spearman correlation analysis, multivariable regression, and adjusted linear mixed-effects models were performed. Results The final analysis included 110 eyes from 110 patients. BCVA and objective optical quality improved during the first postoperative month. During follow-up, DLI, MTF, and SR increased, whereas OSI and HO total decreased. At postoperative month 1, the above-target LDL-C group showed higher OSI and HO Total values and lower MTF and SR values than the at-target group, while BCVA did not differ significantly. After adjustment for potential confounders, above-target LDL-C remained associated with higher HO Total (β = 0.121, 95% CI, 0.034 to 0.207; FDR-adjusted P = 0.049) and lower SR Internal (β = -0.050, 95% CI, -0.086 to -0.014; FDR-adjusted P = 0.049). Correlation analyses also showed associations of TC, TG, and LDL-C with several optical quality measures, whereas no clear association was observed for HDL-C. In the adjusted longitudinal models, LDL-C-related associations were more limited, and the association with BCVA was strongest at postoperative day 1 and attenuated over time. Conclusion Preoperative lipid status may be related to early postoperative objective visual quality after cataract surgery. The clearest differences were observed for LDL-C at postoperative month 1. Further prospective studies are needed to confirm this relationship and clarify its clinical significance.