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D. Claire Miller, Jennifer Patnaik, Anne Lynch, Naresh Mandava, Michael Wildes, Michael Taravella; Risk of posterior capsule rupture in eyes receiving intravitreal anti-VEGF injections prior to cataract surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2068.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients receiving intravitreal anti-VEGF injections within one year prior to surgery.
A retrospective cohort study was conducted of cataract surgeries at the UCHealth Eye Center from January 1, 2014 through December 31, 2016. Patients under age 18, eyes with traumatic cataracts, eyes that had anti-VEGF injections at a different clinic or more than one year prior to surgery, and combination surgeries with pars plana vitrectomy were excluded from the analysis. The primary outcome was occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regressions with general estimating equations to account for correlation between patient eyes.
In total 5529 cataract surgeries were included in the analysis, and 139 of these eyes had received anti-VEGF injections within one year of surgery. Of the 139 eyes that received anti-VEGF injections, 3 (2.2%) had a PCR during surgery compared to 19 of 5390 eyes (0.4%) that did not receive injections (OR=6.2, 95% CI: 1.8 – 21.4, p-value=0.004). Most patients were receiving anti-VEGF injections for neovascular AMD (n=65), or proliferative diabetic retinopathy and diabetic macular edema (n=58). None of the eyes that experienced PCR had any other of type of intravitreal injection prior to surgery. Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at increased risk for PCR, but these variables were not associated with anti-VEGF injection. Over two-thirds of anti-VEGF treated eyes were injected within 30 days prior to surgery (69.8%). Frequency of injections, time between most recent injection and surgery, and type of anti-VEGF agent were not associated with increased risk of PCR.
Previous history of intravitreal anti-VEGF injections within one year of cataract surgery was associated with an increased risk of PCR during surgery. Our sample size of eyes receiving anti-VEGF and having PCR was too small to detect associations with frequency, timing, and type of anti-VEGF treatment, therefore, these clinical aspects warrant further research.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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