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Posterior capsule rupture and IVIs

Recent intravitreal anti-VEGF injection portends increased PCR risk.

Cheryl Guttman Krader

Posted: Saturday, February 1, 2020

atients undergoing cataract surgery are at increased risk of intraoperative posterior capsule rupture if they received an intravitreal anti-VEGF injection within the previous 12 months, according to a retrospective study presented at the 2019 meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, Canada.
The researchers from the University of Colorado School of Medicine, Denver, US, undertook a medical record review to identify patients who had cataract surgery at their institution between January 1, 2014, and December 31, 2016. After excluding eyes of patients aged less than 18 years, those with traumatic cataracts, those that had anti-VEGF injections at a different clinic, or surgery combined with pars plana vitrectomy, their sample included 5,529 eyes, of which 139 had received an anti-VEGF injection within the year before cataract surgery.
Posterior capsule rupture occurred during surgery in three (2.2%) eyes that received anti-VEGF injections and in 19 (0.4%) control eyes without that history. Analysis for predictors of posterior capsule rupture using univariate logistic regression with general estimating equations found that that the odds of posterior capsule rupture were 6.2-fold higher among eyes in the anti-VEGF injection group compared to controls (p=.004).
“Our findings are consistent with those of previous studies that reported the risk of posterior capsule rupture was increased in eyes with a history of intravitreal injections. In contrast to other studies, we chose to specifically focus on an association between posterior capsule rupture and intravitreal injections within the previous year,” D. Claire Miller BS, lead author of the study and research assistant, Department of Ophthalmology University of Colorado School of Medicine, told EuroTimes.
“We were hoping that we might also determine if other variables related to the injections, including the number received, the interval between the most recent injection and cataract surgery, or indication for the anti-VEGF treatment, had an effect on posterior capsule rupture risk. Identifying such associations might provide insights on cause. We are collecting more data to look at those issues in the future because our initial sample size was too small.”
Karen L. Christopher MD, Assistant Professor of Ophthalmology, University of Colorado School of Medicine, noted that a strength of the study is its data collection method.
“The data were harvested by manual extraction from the medical record, which avoids errors that can occur using insurance claims databases in which surgical complications or injection data may be coded incorrectly,” she explained.
Dr Christopher continued, “The primary message of our study is that cataract surgeons should specifically ask patients if they have received anti-VEGF injections, and for those who have, discuss the increased risk of intraoperative complications and take extra care intraoperatively to avoid manoeuvres that may increase susceptibility to posterior capsule rupture.”

D. Claire Miller: claire.c.miller@ucdenver.edu
Karen L Christopher: karen.christopher@ucdenver.edu