Comparative short-term visual outcomes of cataract surgery in dialysis-dependent and non-dialysis CKD patients: a prospective observational study

Background: Cataract is the leading cause of reversible blindness worldwide, and its prevalence is disproportionately higher among chronic kidney disease (CKD) patients due to metabolic, oxidative, and medication-related factors. India’s growing end-stage renal disease (ESRD) population, increasing at 10–15% annually, faces unique challenges in cataract management, particularly those on maintenance dialysis. Limited Indian data exist comparing short-term visual outcomes in dialysis-dependent and non-dialysis CKD patients following modern cataract surgery. Methods: This comparative observational study included 50 eyes from 26 patients 25 eyes (13 patients) in each group: dialysis-dependent CKD (Group A) and non-dialysis-dependent CKD (Group B). All underwent phacoemulsification with intraocular lens implantation, performed by the same surgeon. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and near vision were measured preoperatively and at 4 weeks postoperatively. Statistical analyses included paired and independent t-tests, effect sizes (Cohen’s d), and 95% confidence intervals (CI). Significance threshold: p < 0.05. Results: Both groups showed highly significant improvement in BCVA (p < 0.001 within groups). Group A improved from 0.82 ± 0.31 to 0.20 ± 0.08 logMAR (mean gain: 0.62, 95% CI: 0.51–0.73; d = 2.51), and Group B from 0.78 ± 0.29 to 0.19 ± 0.07 logMAR (mean gain: 0.59, 95% CI: 0.49–0.69; d = 2.54). UCVA gains were similar (both 0.78 logMAR; d > 3.1). No statistically significant between-group differences were found for postoperative BCVA (p = 0.628) or UCVA (p = 0.482). Minor postoperative complications occurred in 12% of eyes in both groups and resolved without sequelae. Conclusion: Short-term visual outcomes after phacoemulsification are comparable between dialysis-dependent and non-dialysis CKD patients, with large effect sizes and minimal complications. These findings suggest that dialysis dependence should not be a barrier to timely cataract surgery when systemic status is optimized, supporting proactive surgical intervention to improve quality of life in this high-risk population.