Author: Marta Belmonte Grau (Spain)
Co-authors: Francisco Javier Moreno-Alemán Sánchez, Rocío Eguilior Álvarez, Muxima Patricia Acebes García
Purpose
To evaluate intraoperative complications during cataract surgery in patients undergoing treatment for age-related macular degeneration.
Setting/Venue
Urban Tertiary hospital. Hospital Universitario de la Princesa, Madrid.
Methods
We conducted a retrospective review of adult patients undergoing phacoemulsification cataract surgery in the macula section of an urban tertiary hospital in Madrid (Spain). Clinical data was anonymized and extracted, including prior administration of intravitreal injections. The variables studied were age, gender, operated eye, presence of risk factors for surgery complication, duration of intravitreal treatment (≤6 or >6 months) and number of intravitreal injections prior to surgery (≤10 or >10). Experience of the surgeon (≤5 or >5 years) and initial and final visual acuity were also included for univariate analysis. All patients previously injected with anti-VEGF due to AMD were analyzed. The main inclusion criterion was phacoemulsification cataract surgery during the study period. We excluded those patients who underwent non-phacoemulsification cataract extraction and those with evidence of posterior capsule rupture before cataract surgery. The primary outcome measure was posterior capsule rupture (PCR) during cataract surgery. The statistical analysis was carried out using the SPSS 25.0 data processing programme. Categorical variables were analyzed using the chi-square test and ccontinuous variables were compared using the t-Student test. To determine the strength of association, the odds ratio (OR) was used with a confidence interval (CI) of 95%. P-value ≤0.05 was deemed statistically significant.
Results
Data was available for 550 cataract surgeries. Of these, a total of 83 eyes (15.09%) had received prior intravitreal injections. 57 were women (68.67%) and 26 (31.33%) men. Mean age was 84.52 ± 6.68 years being the 81.90% (n=68) of the sample over 80 years. Focusing on risk factors for surgery complication, we found 20 eyes with posterior subcapsular cataract (24.10%), 3 eyes (3.60%) with poor dilatation, 2 eyes (2.40%) with mature cataract and 1 eye (1.20%) with pseudoexfoliation syndrome. Patients with posterior subcapsular cataract presented an OR=5.67 (CI 95% [5.67-5.67]; p <0.05) for suffering a complication during the surgery. On examining the complication rate, we observed that 10 eyes (12.05%) presented complications during cataract surgery. The most frequent cause was dislocation of nucleus to the vitreous (n=5, 6%), followed by PCR (n=3, 3.60%) and zonular disinsertion (n=2, 2.40%). In the univariate analysis, we found an increase between preoperative and postoperative visual acuity at 6 months (preoperative Logmar VA: 0.75, postoperative Logmar VA: 0.32) with a mean gain of 0.43 lines (CI 95% [0.28-0.59]; P = 000). Within this study, surgeon experience and number of prior intravitreal injections were not found to be statistically significant risk factors for PCR.
Conlusions
Cataract surgery is the most frequent surgical operation in industrialized countries and intravitreal treatment for AMD has increased exponentially in recent years. These two pathologies are bound to be found more and more in the future, even more so taking into account the aging of the population, as our study shows, where the mean age of the patients was 85 years. The female gender is also more frequent (67%) and thus an elderly woman is the typical patient who receives injections for AMD. Posterior capsule rupture occurs more frequently during cataract surgery in patients who have received previous intravitreal injections and especially those with a posterior subcapsular cataract, probably caused by the needle induced trauma to the posterior capsule during injection. We must therefore insist on a good exploration of the cataract prior to surgery in these patients. A large majority of the complications had to be solved by vitrectomy, so this eventuality must be included in the informed consents and in the information given to the patient.
Financial Disclosure
No financial conflicts
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