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Purpose: To determine whether type 2 diabetes mellitus (T2DM) with and without diabetic retinopathy (DR) is independent risk factor for posterior capsular rupture (PCR) during cataract surgery. Methods: A retrospective study was conducted from 2014 to 2019. Patients from the University of Colorado Cataract Outcomes Database who had undergone phacoemulsification cataract surgery were included. Patients with traumatic, congenital or polar cataracts, type 1 diabetes or less than 18 years old were excluded. The primary outcome was incidence of PCR during surgery in patients with T2DM with and without DR, accounting for previous intravitreal anti-VEGF injections (IVI). Results: A total of 6636 patients were included. A PCR occurred in 59 (0.5%) of 10 893 eyes studied: 35 (0.4%) eyes in patients without diabetes, comparatively to 13 (0.7%) eyes with T2DM without DR (p = 0.142) and 11 (1.8%) eyes with DR (p < 0.0001). All groups with previous IVI demonstrated a significant increase in PCR compared with eyes without IVI or T2DM. In the absence of IVI, T2DM without DR was not significant (p = 0.520), but T2DM with DR had a significantly increased risk of PCR in univariate analysis (OR 3.55, 95% CI: 1.49,8.50, p = 0.004) and an increased risk of borderline significance in multivariate analysis (AOR 2.33, 95% CI: 0.98, 5.56, p = 0.056). Conclusion: Previous IVI is an independent risk factor for PCR. Diabetic retinopathy without previous IVI is likely a risk factor but was of borderline significance due to small sample size. Consideration of PCR risk should be given during surgical planning for patients with DR and/or previous IVI.

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