Can cataract surgery be performed on patients with Hemoglobin A1C (HBA1C) in the prediabetic range?

Cataract Surgery in Patients with Prediabetic HbA1c Levels

Yes, cataract surgery can be safely performed in patients with HbA1c in the prediabetic range, as there is no evidence that prediabetic HbA1c levels alone increase the risk of post-operative complications. 1

Understanding HbA1c in the Perioperative Context

• The most recent evidence shows that cataract surgery does not increase the risk of post-operative endophthalmitis or serious systemic adverse events in diabetic patients across all HbA1c levels, including those in the prediabetic range 1
• Prediabetic HbA1c levels (5.7%-6.4%) do not reliably identify individuals with impaired insulin action or secretion that would significantly impact surgical outcomes 2
• Guidelines specifically addressing cataract surgery note that patients in their usual state of health undergoing cataract surgery do not require preoperative testing 3

Perioperative Recommendations for Cataract Surgery

Preoperative Assessment

• For elective surgeries including cataract surgery, an HbA1c target of <8% is recommended whenever possible, but this is primarily for patients with diagnosed diabetes 3
• Patients with prediabetes do not require special preoperative glucose management for cataract surgery, as this is considered a low-risk procedure 3
• Preoperative glucose assessment should only be undertaken when the results would alter perioperative management, which is rarely the case for prediabetic patients 3

Risk Stratification

• The risk of surgical complications is significantly higher in patients with undiagnosed hyperglycemia than in those with known prediabetes 3
• Patients with prediabetic HbA1c levels who are matched in age and BMI to those with normal HbA1c show no differences in measures of glycemia or glucoregulatory function that would impact surgical outcomes 2
• When considering cataract surgery in patients with prediabetes, focus on other risk factors such as:
  • Advanced age 4
  • Presence of retinal diseases 4, 5
  • Use of hypoglycemic medications 4

Perioperative Management

• For cataract surgery in prediabetic patients:
  • No special glucose monitoring is required during this typically short procedure 3
  • Target blood glucose range in the perioperative period should be 100–180 mg/dL (5.6–10.0 mmol/L) if monitoring is performed 3
  • Early resumption of oral intake after surgery is recommended 3

Important Considerations and Caveats

• While prediabetic HbA1c levels alone should not delay cataract surgery, be vigilant about:

  • Identifying any history of hypoglycemic episodes, which can occur even in prediabetic patients on certain medications 3
  • Recognizing that surgical stress can increase blood glucose levels temporarily, even in prediabetic patients 3
  • Understanding that cataract surgery is specifically identified as a low-risk procedure with excellent evidence-based data to guide decision-making 3

• Common pitfalls to avoid:

  • Unnecessarily postponing cataract surgery based solely on prediabetic HbA1c levels 1
  • Failing to identify patients with undiagnosed diabetes who may have higher surgical risks 3
  • Overlooking other ocular complications that may affect surgical outcomes more significantly than prediabetic status 5, 6

In summary, current evidence strongly supports proceeding with cataract surgery in patients with prediabetic HbA1c levels without special perioperative glucose management, as prediabetic status alone does not increase surgical risk for this procedure.