Posters

The effect of prior intravitreal injections on the rate of posterior capsule ruptures in patients undergoing phacoemulsification cataract surgery: a service evaluation of 4047 procedures performed at a London eye centre

Poster Details

First Author: N.Kainth UK

Co Author(s):    N. Kainth   A. Nagar   J. Luis   B. Singh   C. McKechnie        

Abstract Details

Purpose:

Cataract surgery and intravitreal anti-vascular endothelial growth factor (VEGF) injections are universally performed procedures. Patients undergoing phacoemulsification have been shown to be at an increased risk of surgical complications if prior anti-VEGF injections are given, although evidence is limited. This study compares the risk of intra-operative posterior capsule rupture (PCR) during cataract surgery in patients who have had prior intravitreal anti-VEGF injections versus those who have not. A secondary objective investigates the cumulative risk of PCR in eyes that have received multiple injections. Recommendations based on this study’s outcomes aim to minimise the risk of complications in future operations.

Setting:

A tertiary ophthalmic unit: The Eye Treatment Centre, Whipps Cross University Hospital, London, UK.

Methods:

Anonymised data of cataract procedures performed between August 1st 2016 and January 1st 2018 were collected from an electronic medical record database, Medisoft. Retrospective analysis of variables that included number of previous intravitreal injections (IVIs), intra-operative complications, patient demographics and surgeon grade was conducted. The study sample was divided into two groups: patients that had received at least one intravitreal anti- VEGF injection prior to cataract surgery vs a control group of patients who had no history of intravitreal therapy. Logistic regression analysis was applied to identify any relationship between the occurrence of PCR and previous IVIs.

Results:

4047 phacoemulsification procedures were reviewed. 108 (2.7%) operated eyes had received at least one prior IVI. Three of these eyes were noted to have pre-operative damage to the posterior capsule and thus omitted from analysis. Of the remaining eyes, logistic regression analysis revealed a significant increase in the intra-operative risk of PCR in eyes that received prior IVI compared to those that did not (6.67% vs 1.88%, P< .0001). Moreover, a positive dose-dependent relationship was demonstrated between number of previous IVIs and risk of PCR (P=.0002).

Conclusions:

Prior IVI therapy is significantly associated with an increased risk of PCR in patients undergoing cataract surgery. Efforts should therefore be taken to identify and manage high-risk individuals. For example, at this trust updating risk-stratification tools to include previous IVIs was suggested. In addition, OCT imaging in high-risk patients could be considered. Attempting to reduce pre-operative lens trauma, such as training new injectors on pseudophakic eyes, may help to further minimise risk of PCR during phacoemulsification. Further analysis of larger datasets across multiple centres would strengthen understanding of this issue.

Financial Disclosure:

None