AIM: Diabetic patients are at an increased risk for cataract and may experience delayed postoperative recovery due to diabetes-related ocular tissue vulnerability. However, the impact of preoperative glycemic control on early surgical outcomes and quality of life remains to be fully elucidated. This study aimed to investigate the effects of preoperative fasting blood glucose (FBG) control on postoperative corneal recovery, visual function, and vision-related quality of life in type 2 diabetic patients undergoing phacoemulsification.

METHODS: In this retrospective analysis, 197 cataract patients with type 2 diabetes who underwent phacoemulsification between March 2023 and March 2025 were included. Based on their preoperative FBG levels, they were divided into a well-controlled group (FBG <6.1 mmol/L, n = 83) and a poorly controlled group (FBG ≥6.1 mmol/L, n = 114). National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), mean corneal astigmatism, corneal edema recovery, and best corrected visual acuity (BCVA) were compared between the two groups.

RESULTS: Postoperatively, the well-controlled group had significantly higher total scores and scores on all dimensions of the NEI-VFQ-25 scale than the poorly controlled group (all p < 0.05). Regarding corneal recovery, the group with better control showed greater changes in mean corneal astigmatism on postoperative days 7 and 30 (p < 0.001). The corneal transparency ratio was higher on postoperative day 7 (p = 0.006), while there was no significant difference between the two groups on postoperative day 30. On postoperative day 7, the logarithm of the minimum angle of resolution (logMAR) BCVA of the well-controlled group was also significantly better than that of the poorly controlled group (p < 0.001). By postoperative day 30, the differences in corneal transparency and BCVA between the two groups became non-significant (p > 0.05).

CONCLUSIONS: Good preoperative glycemic control in diabetic patients undergoing phacoemulsification is associated with faster early corneal edema resolution, better early visual recovery, and clinically meaningful improvements in vision-related quality of life. These findings underscore the importance of enhanced perioperative glycemic management to optimize short-term surgical outcomes and health-related quality of life in this population.