Anti-VEGF Injections Prior to Cataract Surgery in Eyes with Diabetic Retinopathy

Abstract

Purpose : The incidence of macular edema after cataract surgery in patients with diabetes mellitus is higher than in the non-diabetic population, with both diabetic macular edema (DME) and pseudophakic cystoid macular edema (CME) correlating with the severity of pre-operative diabetic retinopathy. Treatment with intravitreal anti-vascular endothelial growth factor (VEGF) has shown improvement in the severity of diabetic retinopathy, as well as reduced the incidence of center-involving DME. The purpose of this study is to explore whether pre-operative anti-VEGF treatment has a positive impact on post-operative development or exacerbation of CME/DME in a large clinical database.

Methods : A retrospective study was performed on the Vestrum Health Database (EMR) looking at the incidence rate of macular edema (ME) seen in DR patients following cataract surgery, stratified by anti-VEGF use prior to surgery. Incidence of ME, VA and FT were tracked at 3 and 6 months post-surgery. Patient specific factors such as age, sex, DR severity were also assessed in modeling.

Results : Of 5,383 eyes matching inclusion/exclusion criteria, 4,565 (84%) were diagnosed with DME prior to cataract surgery. The rate of new onset, post-operative ME was 26% at month 3 (M3) and 33% at month 6 (M6) in eyes with no baseline ME. Of the 548 eyes that reported foveal thickness (FT) at baseline, M3, and M6, the FT remained relatively stable with pre-op anti-VEGF (n=347), with mean changes of +11 and +1 µm at M3 and M6. Eyes without pre-op anti-VEGF (n=201) experienced a lasting increase in FT: +25 and +23 µm at M3 and M6. The largest, independent driver of post-operative FT was baseline FT. However, in multiple linear regression modeling, pre-op anti-VEGF had a stabilizing effect on FT on those < 55 years old (p = .006). Multiple linear regression modeling of the 1531 eyes reporting visual acuity (VA) at all time points also demonstrated a beneficial correlation of pre-op anti-VEGF on VA at M3 (p = .0004) and M6 (p = .0008), independent of patient age.

Conclusions : In a systematic, retrospective review of over 5,000 eyes, anti-VEGF treatment prior to cataract surgery may have positive anatomic and functional effects on eyes with diabetic retinopathy and/or DME. Further study is warranted.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.