Prior Intravitreal Injections may Increase Risk of Cataract Surgery Complications: Study
According to a recent study published in the American Journal of Ophthalmology intravitreal injection (IVI) therapy has a greater risk of complications for patients undergoing cataract surgeries. The study was conducted by Cindy Z. and colleagues in the US.
Despite being effective and one of the commonest procedures to restore eyesight, cataract surgery might be impacted by IVI therapy, which is typically used to treat retinal conditions. A retrospective cohort study performed using the TriNetX database evaluated the link between IVI therapy before cataract surgery and the complications arising. Over 500,000 patients were followed for RD, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedures, and endophthalmitis within defined post-operative intervals.
The study compared patients with IVI therapy in the 20 years before cataract surgery with those without any exposure to IVI as a control. Using propensity score matching (PSM), the researchers then balanced the baseline demographics, systemic health, and ocular co-morbid illnesses in the two groups that each contained 14,240 patients. Exclusion criteria included individuals requiring prior lensectomy and pars plana vitrectomy. The outcomes were measured up-to 14 days, up-to 30 days, and up-to 90 days after surgery, using robust statistical analyses.
Results
Complication Rates:
The overall complications were significantly greater within the 90-day period in the IVI group (3.3%, 447/13,719) compared with the control (2.4%, 340/13,945), with a relative risk of 1.34 (95% CI: 1.16–1.54, p<0.0005).
Retinal Detachment and Repairs:
• The 30-day risk escalation of RD repair was demonstrated; RR 1.84 (95% CI: 1.27–2.66, p=0.001) and the 90-day risk escalation of RD repair occurs RR 2.05 (95% CI: 1.65–2.54, p<0.0005).
Anterior Vitrectomy in Certain groups:
• There was no general association with anterior vitrectomy, save for DR patients in whom the risk rose to RR 1.24 (95% CI: 0.85–1.79, p=0.001) at 90 days.
Patients with Diabetes Among Medical Conditions:
• Patients with DR and a prior IVI history showed higher rate risks for lensectomy, RD repair, and secondary lens procedures compared to those without a prior IVI (p<0.0005 for all).
Individuals with previous anti-VEGF therapy are at a remarkably higher risk of complications following cataract surgery, driven chiefly by higher rates of retinal detachment, with added risk for diabetic retinopathy. Inclusion of IVI history in preoperative assessments can facilitate a modification in surgical approaches, thus reducing postoperative risks and enhancing prognosis.
Reference:
Zhao, C. S., Chwialkowski, K., Wai, K. M., Mruthyunjaya, P., Rahimy, E., & Koo, E. B. (2025). Risk of cataract surgery complications in patients with prior intravitreal injection therapy. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2025.01.004
