Purpose:  To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non‐diabetic and diabetic patients. Methods:  Retrospective case‐note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic. Results:  The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non‐diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow‐up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR] = 0.69; 95% confidence interval [CI] 0.47–0.99; P = 0.047), whereas age of 65 years or younger (HR = 1.58; 95% CI 1.09–2.27; P = 0.02), polymethylmethacrylate (PMMA) (HR = 3.98; 95% CI 1.60–9.95; P = 0.003) or plate‐haptic silicone IOLs (HR = 3.75; 95% CI 1.60–8.80; P = 0.002) in comparison with three‐piece silicone IOLs, postoperative inflammation (HR = 2.62; 95% CI 1.56–4.42; P < 0.001) and pars plana vitrectomy (HR = 1.85; 95% CI 1.20–2.83; P = 0.005) were associated with an increased risk. Subgroup analysis showed that in non‐diabetic patients, male gender (HR = 1.63; 95% CI 1.04–2.57; P = 0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy. Conclusion:  Although diabetes mellitus appears to be associated with a lower long‐term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate‐haptic silicone and PMMA IOLs in addition to male gender in non‐diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.

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