Posterior Capsule Rupture during Cataract Surgery in Eyes Receiving Intravitreal anti-VEGF Injections.

PURPOSE: To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery. METHODS: A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rodgers UCHealth Eye Center from January 1, 2014, through December 31, 2018. The primary outcome was the occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regression with generalized estimating equations to account for correlation between patient eyes. Additional sub-analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes. RESULTS: In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8-12.7, p < .0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1-10.4, p-value = 0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with the anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR. CONCLUSIONS: History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.

Pseudophakic rhegmatogenous retinal detachment in a large Asian tertiary eye centre: a cohort study.

BACKGROUND: To determine the incidence and identify risk factors for the development of rhegmatogenous retinal detachment in patients who had cataract surgery at the Singapore National Eye Centre between 2001 and 2003. DESIGN: Retrospective case-control study. PARTICIPANTS: All patients who had cataract surgery between 2001 and 2003 and subsequently retinal detachment surgery in the same eye, between 2001 and June 2008, at Singapore National Eye Centre. METHODS: Review of case records. MAIN OUTCOME MEASURES: Incidence of posterior capsular rupture and retinal detachment. RESULTS: Thirty-nine eyes, out of 24 846 cataract operations performed between 2001 and 2003, developed rhegmatogenous retinal detachment in the follow-up period from 2001 to 2008 (cumulative incidence 0.16%, 95% confidence interval 0.11-0.21%). Of the 508 eyes with posterior capsular rupture during cataract surgery, nine developed retinal detachment (cumulative incidence 1.77%, 95% confidence interval 0.87-3.23%). Men were more likely to develop retinal detachment (P < 0.001). On Kaplan-Meier survival analysis, younger patients had a higher probability of retinal detachment in comparison with older subjects (P < 0.001). Similarly, eyes with posterior capsular rupture during surgery had shorter interval duration to retinal detachment, compared with eyes that did not (P = 0.002). When compared with patients more than 70 years of age, younger patients had significantly higher hazard ratios of retinal detachment (hazard ratio 19.7, 95% confidence interval 3.6-107.3, P < 0.05). CONCLUSION: The incidence of pseudophakic retinal detachment in our institution is low. Posterior capsular rupture during surgery, men and younger age at time of surgery increases the risk of developing retinal detachment, and careful observation for the occurrence of retinal detachment may be warranted in these groups of patients.