Prior intravitreal injections may be associated with risk of postoperative cataract surgery complications

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Investigators from Toronto found that patients who underwent cataract surgery and had a retinal disease that had previously been treated with intravitreal injections had a greater risk of complications following cataract surgery, according to first author Winnie Yu, MD, from the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada. She reported the results of this population-based cohort analysis at the Association for Research in Vision and Ophthalmology annual meeting in Seattle.

It was unclear if there was a higher risk of cataract surgery complications in patients who previously received intravitreal injections, in turn, Yu and colleagues undertook a population-based cohort study to detect any differences in risks in these patients.

To carry out the study, the investigators accessed the Ontario Health Insurance Plan (OHIP) data to identify adults 20 years of age and older with a retinal disease who had undergone a cataract surgery from 2009 to 2018. They defined the patients who underwent bilateral intravitreal injections within 20 days before the cataract surgery as the exposed group and the patients with retinal disease who had not undergone intravitreal injections during that time period as the unexposed group. The patients treated with only 1 intravitreal injection were excluded. After the cataract surgery, patients were followed for 3 months to identify complications that included vitreous hemorrhages that did not clear, retained lens fragments, retinal detachment, and retinal tear; they were followed for 2 years for corneal transplantation, intraocular lens (IOL) exchange, IOL repositioning, and glaucoma surgery.

Results of data analysis

The investigators identified 170,428 adults who had a retinal disease and underwent cataract surgery. The investigators reported that of those, 5,960 patients (53.4% female; age over 65 years, 75.7%) were in the exposed group and 164,468 in the unexposed group.

The analysis showed an association between patients who previously had undergone intravitreal injections and a cataract surgery and a higher risk of the development of a non-clearing vitreous hemorrhage, retinal detachment, retinal tear, and glaucoma surgery (p<0.0001 for all comparisons).

In addition, a non-significant increased risk was seen for retained lens fragments, corneal transplantation, and IOL repositioning. The average hazard ratio for IOL exchange was 1.00 (p=0.99).

The authors concluded, “Cataract surgery patients with retinal disease who previously received intravitreal injections had a greater risk of post-cataract surgery complications of non-clearing vitreous hemorrhage, retinal detachment, retinal tear, and glaucoma surgery. These findings should be considered in the preoperative counseling of cataract patients.”

Reference:

Yu W, Jin Y, Muni RH, et al. Cataract surgery complications in individuals who previously received intravitreal injections: a population-based cohort analysis. Paper presented at: Association for Research in Vision and Ophthalmology annual meeting; May 5-9, 2024; Seattle, WA. Presentation number: 3849