Intravitreal Injection Is Associated with Increased Posterior Capsule Rupture Risk during Cataract Surgery: A Meta-Analysis

Abstract

Background: Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. Objective: To summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. Methods: A systematic literature search was performed up to October 27th, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: “pooling the odds ratios of PCR in eyes with and without previous IVI(s)” and “pooling the odds ratios for PCR relative to each increase in the number of prior injections.” The quality of included studies was appraised using the Newcastle-Ottawa Scale. Results: 6 cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35–3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01–1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. Conclusion: This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.

Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration

“…8,9,12 There is a much wider range (1.41% to 7%) reported in the literature for PCR in eyes that previously received intravitreal injections. 13 We found a similar PCR rate between the NvAMD and the reference groups (2.90% vs 2.77%). In agreement with other studies, our logistic regression model found a higher likelihood of PCR in eyes receiving ≥10 intravitreal injections before cataract surgery.…”

“…In agreement with other studies, our logistic regression model found a higher likelihood of PCR in eyes receiving ≥10 intravitreal injections before cataract surgery. 13,14 We postulate that repeated intravitreal injections in NvAMD may be associated with lenticular trauma, possibly leading to less integral support of the capsule structure. Another possibility is the inadvertent iatrogenic trauma to the zonular fibers at the time of injection leading to capsular instability at the time of cataract surgery, possibly increasing the risk for PCR.…”

“…11,12 A recent metaanalysis concluded that there is a significantly higher odds of PCR by 2-folds if an eye has received intravitreal injections vs those without a history of intravitreal injections. 13 It is imperative to understand the perioperative risk factors better so that we can educate and counsel our patients on cataract surgery outcomes and safety. With the limitations of the current literature in mind, we conducted this large-scale study to answer the following questions: (1) what is the rate of intraoperative complications of cataract surgery in eyes with NvAMD compared with non-NvAMD eyes?…”

“…11,12 A recent meta-analysis concluded that there is a significantly higher odds of PCR by 2-folds if an eye has received intravitreal injections vs those without a history of intravitreal injections. 13…”

Linsenverletzungen als Komplikation bei intravitrealer Medikamenteneingabe

“…Interessanterweise beschreiben neuere Studien einen höheren Anteil an hinteren Kapselrupturen (HKR) während der Kataraktoperation bei Patienten, die vor- her eineIVOM-Behandlungerhaltenhaben [14][15][16]. Dabei korreliert die Inzidenz an HKR mit der Anzahl an Injektionen, ohne dass eine offensichtliche Schädigung der hinteren Kapsel vorlag.…”