Abstract
Purpose :
It is uncertain whether the risk of cataract surgery complications is higher in patients who previously received intravitreal injections (IVI). A population-based cohort study was conducted to determine whether there are differences in the risk of complications following cataract surgery in patients with retinal disease who previously received IVI vs those with no IVI history.
Methods :
Using physician billing data from the Ontario Health Insurance Plan (OHIP), we identified adults (age ≥20 years) with retinal disease who had cataract surgery between 2009 to 2018. Patients who received bilateral IVI treatments (two IVI OHIP records within 20 days) prior to cataract surgery were considered the exposed group, whereas patients with retinal disease and no prior IVI record were considered the unexposed group. Patients with unilateral IVI treatment were excluded. Patients were followed after cataract surgery to determine complication events, for up to 3 months (non-clearing vitreous hemorrhage, retained lens fragments, retinal detachment, retinal tear) and 2 years (corneal transplant, intraocular lens (IOL) exchange, IOL repositioning, glaucoma surgery). Adjusted hazards ratios (aHR) with 95% confidence intervals (CI) were derived from multivariable Cox proportional hazards models.
Results :
There were 170,428 adults identified in our cohort with retinal disease and cataract surgery. Of those, 5,960 were in the exposed group and 164,468 in the unexposed group. The majority were female (53.4%) and aged 65+ (75.7%). There was an association between patients who previously received IVI and a greater risk of non-clearing vitreous hemorrhage (aHR 3.04, 95% CI 2.42–3.82, p<.0001), retinal detachment (aHR 2.57, 95% CI 1.78–3.70, p<.0001), retinal tear (aHR 2.66, 95% CI 2.03–3.49, p<.0001) and glaucoma surgery (aHR 3.36, 95% CI 2.51–4.49, p<.0001). A non-significant increased risk association was seen in retained lens fragments, corneal transplant and IOL repositioning. The aHR for IOL exchange was 1.00 (p=0.99).
Conclusions :
Cataract surgery patients with retinal disease who previously received IVI had a greater risk of post-cataract surgery complications of non-clearing vitreous hemorrhage, retinal detachment, retinal tear and glaucoma surgery. These findings should be considered in the pre-operative counselling of cataract patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.