From the Guidelines
Jardiance (empagliflozin) should be stopped at least 3 days before cataract surgery. This recommendation is based on the most recent and highest quality evidence from the 2025 standards of care in diabetes, which suggests that SGLT2 inhibitors, such as empagliflozin, should be discontinued 3-4 days before surgery 1. The primary concern with continuing Jardiance during surgery is the risk of dehydration and electrolyte imbalances, which could complicate surgical procedures and recovery.
Key Considerations
- The medication's mechanism as an SGLT2 inhibitor affects blood glucose levels and can potentially impact surgical outcomes.
- Patients should consult with both their ophthalmologist and the physician who prescribed Jardiance to determine the exact timing for their specific situation.
- During this perioperative period, blood glucose levels should be closely monitored, and alternative diabetes management strategies may be temporarily implemented.
- The medication's effects on blood pressure and volume status could interact with anesthesia.
Perioperative Management
- Patients should clearly communicate all medications they're taking to their surgical team and follow their healthcare providers' specific instructions for resuming Jardiance after surgery, which typically occurs once normal eating patterns are established and the immediate recovery period has passed.
- A preoperative risk assessment should be performed for people with diabetes who are at high risk for ischemic heart disease and those with autonomic neuropathy or renal failure, as recommended by the 2025 standards of care in diabetes 1.
- The blood glucose goal in the perioperative period should be 100–180 mg/dL (5.6–10.0 mmol/L) within 4 h of the surgery, and continuous glucose monitoring (CGM) should not be used alone for glucose monitoring during surgery 1.
From the Research
Jardiance (Empagliflozin) and Cataract Surgery
- There is no direct evidence regarding the use of Jardiance (Empagliflozin) before cataract surgery 2, 3, 4, 5, 6.
- However, studies suggest that anticoagulants and antiplatelet drugs can be continued during cataract surgery, as the risk of hemorrhage is low if the international normalized ratio is in the therapeutic range 2.
- Aspirin can be safely continued in patients undergoing cataract surgery, with a significant increase in subconjunctival hemorrhage risk, but no increase in potentially sight-threatening bleeding events 4.
- The decision to stop or continue Jardiance (Empagliflozin) before cataract surgery should be made on a case-by-case basis, considering the patient's individual risk factors and medical history.
- It is essential to note that Jardiance (Empagliflozin) can cause dehydration, particularly in elderly patients or those with neurological deficits, and careful assessment of dehydration and preventive water intake is recommended 5.
Considerations for Cataract Surgery
- Cataract surgery is a low-risk procedure, and the benefits of sight restoration and preservation are enormous 3.
- The use of topical or regional anesthesia with minimum or no sedation is preferred, as it carries a low risk of adverse outcomes 3.
- Patients undergoing cataract surgery are generally elderly and may have comorbid medical conditions, making it crucial to consider the risks and benefits of continuing or discontinuing medications perioperatively 2, 3, 4.