Previous anti-VEGF injections tied to an increased risk of surgical PCR

This single-center study investigates whether previous intravitreal anti-VEGF injections are a predictor for posterior capsular rupture (PCR) during phacoemulsification.

Study design

The authors examined electronic medical records from 4,047 cataract operations performed between August 2016 to January 2018; 108 had previously received anti-VEGF injections. Three of the eyes were noted to have preoperative posterior capsule trauma and were excluded from the final analysis, leaving only eyes with normal and intact posterior capsules in the analysis.

Outcomes

A logistic regression analysis revealed an increased risk of PCR in the anti-VEGF group compared with the noninjected group (6.67% vs 1.88%, P<0.0001). In addition, there was a dose-dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. Thus, it appears that previous intravitreal anti-VEGF injections are significantly correlated with increased risk of surgical PCR, even in the absence of visible structural damage to the posterior capsule preoperatively.

Limitations

This was an EMR-based study with limited subjects to evaluate in the database. Its retrospective design limits the availability of preoperative images of the cataract and the structural integrity of the posterior capsule. The subgroup analyses lacked statistical power.

Clinical significance

Within the last decade, nothing has transformed the treatment patterns of patients in ophthalmology more than anti-VEGF therapy. This has been revolutionary in the field of retina as well as comprehensive ophthalmology.

Because of the increased treatment burden for both the patient and the doctor, we now observe and treat patients who previously would have gone blind and can see once again, but might need cataract surgery thereafter. These patients are typically advanced in age and have other ocular comorbidities such as cataract. Furthermore, most cataract surgeons are starting to perform their own intravitreal injections and should be more acutely aware of these findings. If this is proven true in larger trials, this will be something that should be changed on informed consents for every patient who has concomitant cataract surgery and intravitreal injections. While we don’t know definitively if this will hold true in further datasets, we should be monitoring this very closely in the near future.