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To evaluate the association between cataract surgery and diabetic retinopathy (DR) progression in the Thai population. This was a retrospective analysis of 200 eyes of 100 patients with diabetes who underwent cataract surgery in one eye, using the non-operated fellow eye as a control to minimize confounding factors. Outcomes were assessed at 12 months postoperatively. Potential risk factors were explored using logistic regression analysis. DR progression occurred more frequently in the operated eyes than it did in the non-operated eyes (21% vs 13%, P = .004). However, the progression of macular edema was not significant between the groups (10% vs 9%, P = .740). Higher hemoglobin A1c levels and preexisting DR were identified as significant risk factors for retinopathy progression (P = .044 and .038, respectively). Cataract surgery might be associated with DR progression, particularly in patients with poor glycemic control or preexisting DR. Careful preoperative evaluation and close postoperative monitoring are essential to optimize visual outcomes and minimize complications in patients with diabetes undergoing cataract surgery.