Impact of Intravitreal Anti-VEGF Injections on Cataract Development

To evaluate the association between intravitreal anti-VEGF injections and incident cataract surgery.

Retrospective, interventional case series.

Patients with phakic lens status in both eyes at baseline who received 12 or more unilateral anti-VEGF injections.

Electronic medical records were analyzed to compare the incidence of cataract surgery between injected eyes (receiving anti-VEGF treatment) and untreated fellow eyes. Cumulative incidence was assessed using the Kaplan-Meier survival analysis. Lens opacity grades at the time of surgery and change in best-corrected visual acuity before and after the surgery also were analyzed.

Hazard ratio (HR) and 95% confidence interval (CI) for incident cataract surgery in the injected eye compared with the fellow eye.

A total of 603 patients were followed up for a median of 74 months. The 10-year cumulative incidence of cataract surgery was 40.7% (95% CI, 35.9%-45.1%) and 7.2% (95% CI, 4.1%-10.3%) in the injected and fellow eyes, respectively. The injected eye (HR, 8.174; 95% CI, 5.767-11.586) and older age (HR, 1.069; 95% CI, 1.052-1.086) were associated with an increased risk of cataract surgery. At the time of surgery, all lens opacity grades, including nuclear, cortical, and posterior subcapsular, were significantly higher in injected eyes (P < 0.001 for all), with the greatest difference observed in posterior subcapsular opacity.

Long-term intravitreal anti-VEGF treatment was associated with a significantly increased risk of cataract developing for which surgical intervention was performed.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.