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joseph James raevis, Amirfarbod Yazdanyar, Johnny Xiang Li, Azam Zaki, Fahd Yazdanie, Eric Shrier; Cotton-Tip Applicator Lid Retraction Intravitreal Injections and Cataract Associations. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5724.
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The cotton-tip applicator (CTA) method for lid retraction is a new technique for elevating the eyelid during intravitreal injections and one that has yet to be fully established as equivalent to other methods. We describe the first retrospective, observational clinical study to examine the effects that superior temporal intravitreal injections have on cataract development and intraocular pressure (IOP) changes after cataract surgery.
We performed a retrospective chart review of 479 consecutive charts from patients receiving superior temporal quadrant intravitreal injections of Bevacizumab and Aflibercept using the CTA Technique. Of these patients, 263 had multiple intravitreal injections and were included in this study. The reason for intravitreal therapy, preoperative and postoperative IOP, cataract development that required surgery, and best corrected visual acuity (BCVA) were collected for all patients.
Of the 263 patients examined, 18 patients developed a total of 24 visually significant cataracts that warranted surgery. African Americans comprised 53% of the patients in this study, with Caucasians, Hispanics and Asians representing 30%, 10% and 4% respectively. Males and females were equally represented at 50%, but 15 cataracts developed in males while 9 cataracts developed in females (p= 0.22), no cataracts developed within 1 week of intravitreal therapy. Diabetic macular edema, macular degeneration, and vein occlusions were the most common indications for therapy, accounting for 38%, 37% and 20% of patients respectively. After cataract surgery, the average IOP declined by 2.2mmHg (SD pre-OP= 4.7, SD post-OP= 3.1, p= 0.04, Figure 1) while the average BCVA improved from a mean logMAR 0.81 to 0.78 (SD pre-OP= 0.77, SD post-OP= 0.71, p= 0.80).
Intravitreal injections in the superior temporal quadrant with the CTA method for lid retraction did not lead to any increase in cataracts due to lenticular damage from the injection. When cataracts did form after intravitreal therapy with Bevacizumab or Aflibercept, there was a significant drop in IOP but not a significant improvement in the BCVA which is likely due to the underlying pathology.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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