Risk of Cataract Surgery Complications in Patients With Prior Intravitreal Injection Therapy

To compare cataract surgery complications in patients with and without prior intravitreal injection (IVI).

A retrospective cohort study using the TriNetX aggregated research network.

Patients with IVI therapy within twenty years of cataract surgery were compared to controls using propensity score matching (PSM) to balance for demographics, systemic, and ocular co-morbidities. Patients with lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded.

IVI within twenty years of cataract surgery.

Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery.

Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI:1.16-1.54) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI:1.27-2.66) and 90 days (RR 2.05; 95% CI:1.65-2.54). IVI was only associated with higher rates of anterior vitrectomy in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI:0.85-1.79). Patients with DR and IVI exposure had more lensectomies, RD repairs, and secondary procedures.

Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.