The Risk of Posterior Capsule Rupture during Phacoemulsification Cataract Surgery in Eyes with Previous Intravitreal Anti Vascular Endothelial Growth Factor Injections.

PURPOSE

To investigate if previous intravitreal anti vascular endothelial growth factor (VEGF) injections are a predictor for posterior capsule rupture (PCR) during phacoemulsification cataract surgery.

SETTING

National Health Service: Whipps Cross University Hospital Eye Treatment Centre. District General, London, United Kingdom DESIGN:: Single centre, retrospective, electronic medical record (EMR) database study with univariate analysis.

METHODS

EMR (Medisoft) was used to extract data for eyes undergoing phacoemulsification surgery between 01.08.16 to 01.01.18. Patient demographics, indication for intravitreal therapy, treatment type, number of previous intravitreal injections (IVI), diabetic status, surgeon grade and operative complications were included as variables for analysis.

RESULTS

Data was available for 4047 cataract operations. Of these, 108 had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have pre-operative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that prior anti-VEGF IVI treatment was associated with an increased risk of PCR when compared to the non IVI group (9.26% vs 1.88%, p<0.0001). There is a dose dependent relationship between the number of anti-VEGF injections and the likelihood of PCR.

CONCLUSIONS

Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR despite the absence of visible structural damage to the PC pre-operatively.