Retrospective analysis of Duke Eye Center records and U.S. Medicare claims data showed a higher rate of cataract surgery-related complications in eyes that previously underwent intravitreal injections.
The Duke study identified 197 eyes with history of prior intravitreal injection in 10,105 cataract surgeries performed, and compared them with an equal number of control eyes, matched by age and surgeon.
“The rate of intraoperative complications such as [posterior capsule] rupture, anterior vitrectomy and unplanned IOL replacement was 3% in the intravitreal injection group vs. 0% in the control group. In these six patients, the visual outcome ranged between 20/20 and hand motion, and two of them ended up with worse vision following cataract surgery,” Paul Hahn, MD, PhD, said at the American Society of Retina Specialists meeting. None of the cases had documented lens trauma during injection.
On Medicare claims records, in 278,199 cataract surgeries performed between 2009 and 2013, a 0.3% increased risk of endophthalmitis was found in association with anti-VEGF therapy.
“The risk may be due to the intravitreal injections themselves, but further studies are needed to determine if intravitreal injections modulate the risk of post-cataract endophthalmitis,” Hahn said.
“Although no clinically apparent lens trauma may occur, more often than we think we might be grazing the lens unknowingly,” he said.
Hahn recommended intimate understanding of the eye anatomy, especially because non-retina-trained providers increasingly may be performing intravitreal injections.
“It is important not to be cavalier on how this procedure is performed,” he said. — by Michela Cimberle
Disclosure: Hahn reports no relevant financial disclosures.