AIM: To evaluate the association between preoperative systemic inflammatory indices (systemic immune-inflammation index [SII], systemic inflammation response index [SIRI], and aggregate index of systemic inflammation [AISI]) and poor visual outcomes following cataract surgery.

METHODS: This retrospective study included 240 patients who underwent cataract surgery between April 2022 and June 2025. SII, SIRI, and AISI were calculated from complete blood counts obtained within 7 days preoperatively. Poor visual outcome at 4 weeks postoperatively was analyzed using multivariable logistic regression and restricted cubic spline models, with adjustment for potential confounders.

RESULTS: The mean age was 69 years, and 67.1% of participants were female. SII demonstrated a nonlinear association with poor postoperative visual outcomes (p for nonlinearity = 0.029), with increased odds observed at SII values of 500–1000 and at extremely low levels. Compared with the lowest tertile, the highest SII tertile was associated with a significantly increased risk (adjusted odds ratio [OR] 2.790, 95% confidence interval [CI] 1.209–6.615; p = 0.018). After adjustment for sex, body mass index (BMI), and intraocular pressure, SIRI (tertile 3 vs. tertile 1: OR 2.019, 95% CI 1.035–3.997; p = 0.041) and AISI (tertile 2 vs. tertile 1: OR 1.977, 95% CI 1.017–3.898; p = 0.046) were also associated with poor visual outcomes. In multivariable analyses, SII and AISI remained independently associated with poor postoperative vision (OR 2.790, 95% CI 1.209–6.615; p = 0.018; OR 2.104, 95% CI 1.016–4.432; p = 0.047).

CONCLUSIONS: Preoperative SII, SIRI, and AISI were significantly associated with worse short-term visual outcomes after cataract surgery. These indices, particularly SII and AISI, may provide clinically useful information for perioperative risk stratification. Further prospective validation studies and investigation of targeted anti-inflammatory strategies are warranted.