Cataract surgery in eyes with a pre-existent posterior capsule rupture after intravitreal anti-VEGF injections

Session Details

Session Title: Capsular Management

Session Date/Time: Sunday 23/09/2018 | 16:30-18:00

Paper Time: 16:54

Venue: Room A4

First Author: : L.Spekreijse THE NETHERLANDS

Co Author(s): :    T. Berendschot   H. Beckers   N. Visser   R. de Crom   C. Webers   R. Nuijts   I. Saelens  

Abstract Details

Purpose:

The introduction of anti-VEGFs as a treatment for macular edema in cases of age-related macular disease, diabetic macular edema and retinal vein occlusion, has resulted in a worldwide increase in the number of intravitreal injections (IVI). One of the complications that may occur is lens injury, resulting in a posterior capsule rupture (PCR) and cataract. Pre-existing PCR challenges cataract surgeons during removal of the clouded lens, due to an increased risk of complications. The aim of this study is to evaluate management and outcomes of cataract surgery in eyes with pre-existing PCR due to IVIs with anti-VEGFs.

Setting:

University Eye Clinic Maastricht, Maastricht University Medical Center, the The Netherlands

Methods:

We retrospectively reviewed all consecutive medical records of patients with a history of IVI that underwent cataract surgery from January 2016 until December 2017 at the University Eye Clinic Maastricht. In addition, the medical records of patients (including referred patients) with a pre-existing PCR and history of IVI that underwent cataract surgery were reviewed. In these eyes, intraoperative management of cataract was evaluated. Outcome measures included intraoperative and postoperative complications, corrected distance visual acuity (CDVA) and intraocular pressure (IOP). The level for significance was set at P=0.05.

Results:

Out of 6589 phacoemulsifications, 48 eyes (38 patients) had a history of IVI (0.73%). Pre-existing PCR was present in one eye(2%) and in one eye PCR occurred peroperatively(2%). Additionally, 8 eyes (7 patients) had pre-existing PCR and history of IVI (mean follow-up:1.16 months; range:0.03-3.65). Peroperatively, anterior vitrectomy was performed in 6 eyes(75%),of which a partial dropped nucleus occurred in one eye. Four weeks postoperatively, we found a mean CDVA of 0.54±0.47 logMAR (Snellen 0.3) and a mean IOP of 12±3 mmHg, significantly better than the preoperative values of 0.83±0.44 logMAR (Snellen 0.16;P=0.03) and 17.4±3.1 mmHg(P=0.04), respectively.

Conclusions:

Cases of pre-existing PCR that undergo cataract surgery are a challenge to surgeons. Nonetheless, adjustment of surgical technique may result in an acceptable rate of complications and a significant improvement of postoperative CDVA and IOP.

Financial Disclosure:

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