Author: João Leite (Portugal)
Co-authors: Catarina Castro, Ana Carolina Abreu, Bernardete Pessoa, Miguel Lume, Pedro Menéres
Purpose
To evaluate the risk of posterior capsular rupture (PCR) during cataract surgery in eyes treated previously with intravitreal antivascular endothelial growth factor (anti-VEGF) and/or steroids injections.
Setting/Venue
Centro Hospitalar Universitário do Porto, Oporto, Portugal.
Methods
Retrospective, observational study that included consecutive eyes submitted to phacoemulsification cataract surgery (PCS), between November of 2019 and October of 2020. Combination surgeries with pars plana vitrectomy or glaucoma surgery were excluded from the analysis. The primary outcome was the rate of occurrence of PCR during surgery in eyes with or without previous treatment with intravitreal injections. Other variables including age, the presence of ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection were also recorded.
Results
A total of 2227 cataract surgeries were included in this study and 100 (4.5%) of these eyes had received previous treatment with intravitreal injections (IVI) for diabetic macular edema (62.0%), age-related macular degeneration (19.0%), vascular occlusion (11.0%) and other causes (8.0%). These eyes were treated with anti-VEFG alone (75.0%), an association between anti-VEGF and steroids (20.0%) or with steroids alone (5.0%). Globally, the rate of PCR during PCS was 1.6% (n=35): in patients with previous treatment with IVI the rate was 8.0% (n=8) and 1.2% (n=27) in the eyes without previous treatment with IVI (OR = 6.8, 95% CI: 3.0-15.3, p<0.001). Analyzing the group with previous IVI, the majority of the PCR occurred in eyes with ≥ 10 previous IVI (87.5%), with a time interval between the date of the last IVI and the surgery <6 months (in 87.5%) and without ocular comorbidities (in 75%). There was no significant relationship between PCR and age (p=0.288 and p=0.855), diabetes (p=0.623 and p=0.318), mature cataract (p=0.280 and p=0.036) and the relationship between the degree of training of the surgeon and the rate of PCR (p=0.613 and p=0.406) in both groups (with prior IVI history and globally).
Conlusions
Our study, conducted in a central service with a high formative vocation, shows that eyes with previous treatment with IVI have a higher risk of PCR during cataract surgery and highlights the need for careful preoperative evaluation of the posterior capsule in these eyes.
Financial Disclosure
NO
Comments
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