Complication Rate During Cataract Surgery After IVT Injections
Published online May 27, 2016
In a retrospective cohort analysis, Hahn et al. examined the effect of prior intravitreal (IVT) injections on intraoperative and postoperative complications of cataract surgery. They found an increase in intraoperative, but not postoperative, complications in patients who had received IVT injections.
The authors reviewed 10,105 cataract surgery procedures performed at the Duke Eye Center from Jan. 1, 2005, to Dec. 10, 2012. From these, they compared 197 eyes that had undergone IVT injections against an equal number of matched control eyes that had not been injected.
The analysis included baseline demographics, preoperative clinical characteristics, prevalence of intraoperative complications, preoperative and postoperative intraocular pressure (IOP), glaucoma surgery, and the use of glaucoma medication through year 1 after cataract surgery.
The researchers identified an increased rate of intraoperative complications in eyes that had undergone prior IVT injections compared with control eyes (3% vs. 0%; p = .030). Intraoperative complications were defined a priori as posterior capsular rupture and/or anterior vitrectomy and/or unplanned placement of a 3-piece IOL. Injected eyes required more glaucoma medications at 1 year, but there was no difference when steroid injections were excluded. No differences were seen in postoperative IOP or glaucoma surgery, and no cases of endophthalmitis were reported.
The authors hypothesized that the increased complications might be the result of inadvertent needle-induced trauma to the posterior capsule of the lens during IVT injection. However, they noted that the retina physicians had not documented lens trauma in any of these eyes.
They added that with increasing need and indications for IVT therapy, treatment may be administered by non-retina specialists. The authors emphasized that all physicians who perform IVT injections should have a thorough understanding of intraocular anatomic relationships. This is particularly important with the posterior segment and the lens, whose relationships are altered as the eye is torqued during the injection procedure.
Similarly, cataract surgeons should perform careful preoperative assessments of the posterior capsule in patients with a history of IVT injection. Further, they should understand precautions and surgical procedure modifications that can minimize complications associated with preexisting posterior capsule defects.
Adult Strabismus Surgery Can Improve QOL and Mood
Published online April 29, 2016
McBain et al. conducted a longitudinal study to assess the impact of adult strabismus surgery on clinical and psychosocial well-being and to determine the factors associated with patient satisfaction and quality of life (QOL) after surgery. They found that a large majority of patients were satisfied with their surgery and experienced psychosocial improvement, but a minority of patients had a deterioration in QOL.
The 210 participants in this study were adults (mean age, 46 years) who had strabismus surgery between November 2010 and April 2012 at Moorfields Eye Hospital in London. Preoperatively and at 3 and 6 months postoperatively, participants completed the AS-20 (a validated strabismus-specific QOL assessment of functional and psychosocial measures) as well as surveys of mood, expectations for surgery, and beliefs about their disease, appearance, and social and intimate relationships. They also underwent a complete orthoptic assessment at their preop visit and again at 3 months postoperatively. The researchers classified the clinical outcomes as successful, partially successful, or failure, based on largest remaining angle of deviation, diplopia, and need for further therapy.
Satisfaction was high with strabismus surgery: More than 80% of patients did not regret having had surgery, and only 1% to 4% would not go through the surgery again. Overall, strabismus surgery led to statistically significant improvements in psychosocial and functional QOL. Paradoxically, however, the authors found that surgery deemed to be partially successful was more psychologically detrimental than that classified as successful or a failure.
The statistically significant predictors of QOL and psychosocial improvement were participants’ beliefs about their disease, perceived visibility of strabismus, social support from significant others, and depression. The authors found that improvement in QOL after surgery was more likely in those who, preoperatively, held more positive beliefs about their strabismus and treatment, experienced less social anxiety and social avoidance, and had lower expectations about the outcome of their surgery. The authors concluded that recognition of clinical and psychosocial factors related to strabismus can help physicians and researchers develop interventions that can improve postsurgical QOL.
Nuclear Cataract Is an Early Predictor of Recalcitrant JIA-Associated Uveitis
Journal of AAPOS
Suelves et al. analyzed factors predictive of treatment-resistant uveitis among patients with juvenile idiopathic arthritis (JIA)–associated uveitis. They found that the presence of nuclear cataract at the baseline evaluation is a risk factor for recalcitrant uveitis, defined as requiring biologic disease-modifying antirheumatic drugs or alkylating agents for management.
The investigators retrospectively reviewed the medical records of patients diagnosed with JIA-associated uveitis who were treated at a single tertiary referral center between October 2005 and March 2013. The study’s main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies.
A total of 96 patients (175 eyes), aged 1 to 12 years, were included in the study. Of these, 58 patients (108 eyes) were classified into the recalcitrant group, and 38 patients (67 eyes) into the nonrecalcitrant group. The eyes of the recalcitrant group had a higher incidence of cataract at baseline (49%; p < .0001), and these cataracts tended to have a nuclear component. In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%).
In this exploratory study of risk factors, univariate analysis showed that having posterior synechiae, active uveitis, cataract, or any ocular complication at presentation was associated with a recalcitrant course; however, after multivariate analysis was performed, the researchers found that only nuclear cataract was an independent risk factor for recalcitrance (adjusted odds ratio, 14.22; p = .002).
The authors commented that despite improved screening guidelines and earlier initiation of immunomodulatory drugs, 44% of eyes in the nonrecalcitrant group and 72% of eyes in the recalcitrant group had at least 1 ocular complication at presentation. Currently, ocular prognosticators are not included in screening guidelines or disease classification. They concluded that identifying patients at higher risk for recalcitrant JIA-associated uveitis is important in making informed treatment decisions and improving care.
Other Journals summaries are written by Marianne Doran and edited by Deepak P. Edward, MD.
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