Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections

ABSTRACT

Purpose

To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery.

Methods

A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rodgers UCHealth Eye Center from January 1, 2014, through December 31, 2018. The primary outcome was the 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 regression with generalized estimating equations to account for correlation between patient eyes. Additional sub-analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes.

Results

In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8–12.7, p < .0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1–10.4, p-value = 0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with the anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR.

Conclusions

History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.

KEYWORDS:

• Posterior capsule rupture
• anti-vascular endothelial growth factor
• intravitreal injection

Author’s contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by D. Claire Miller and Jennifer L. Patnaik. The first draft of the manuscript was written by D. Claire Miller and Karen L. Christopher, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Availability of data and materials

The dataset generated and analyzed during the current study is not publicly available as they were obtained from the University of Colorado Cataract Outcomes Database but may be available from the corresponding author on reasonable request.

Disclosure statement

The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Colorado Multiple Institutional Review Board (protocol # 17-0629) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Funding

Support from a Challenge Grant to the Department of Ophthalmology from Research to Prevent Blindness, Inc., Research to Prevent Blindness [Challenge Grant].