Risk of posterior capsular rupture during phacoemulsification cataract surgery in eyes with previous intravitreal antivascular endothelial growth factor injections

Abstract

The Royal College of Ophthalmologists (RCOphth) is the professional body for eye doctors, who are medically qualified and have undergone or are undergoing specialist training in the treatment and management of eye disease, including surgery. As an independent charity, we pride ourselves on providing impartial and clinically based evidence, putting patient care and safety at the heart of everything we do. Ophthalmologists are at the forefront of eye health services because of their extensive training and experience. The Royal College of Ophthalmologists received its Royal Charter in 1988 and has a membership of over 4,000 surgeons of all grades. We are not a regulatory body, but we work collaboratively with government, health and charity organisations to recommend and support improvements in the coordination and management of eye care both nationally and regionally. Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies.

Risk of Posterior Capsular Rupture during Phacoemulsification in Patients with the History of Anti-VEGF Intravitreal Injections: Results from the Pan-American Collaborative Retina Study (PACORES) Group

“…The prevalence of PCR observed in our patients with a history of intravitreal anti-VEGF therapy was 7.45% (95% CI: 5.9–9.32%). Despite this value representing the pooled prevalence from surgeons with various levels of experience, it is remarkable because it is significantly higher than that found in previous reports [ 9 – 11 ]. The reason for such an increase is unknown.…”

“…These authors successfully identified through multiple logistic regression models that the experience of the cataract surgeon (OR: 1.83–2.83), cataract progression grade (OR: 2.67–2.84), number of previous intravitreal injections (>10, OR: 2.59), and male sex (OR: 1.49) were potential associated risk factors for PCR [ 9 , 10 ]. Finally, in early 2020, another group identified a dose-dependent increase of 8.6% (OR: 1.086, 95% CI: 1.04–1.135, p < 0.01) in relative risk per injection, especially in those receiving more than 10 injections [ 11 ]. Eventhough the evidence is compelling, there are some contradictions among the different studies.…”

“…Increasing evidence suggests that a history of prior intravitreal injections increases the risk of posterior capsular rupture (PCR) during routine phacoemulsification [ 7 – 11 ]. Although the mechanism of capsular damage is still unknown, mechanical capsular damage via inadvertent posterior microtrauma by the injection, or even uncharacterized biochemical damage, has been mentioned as a potential cause.…”

“…Although the mechanism of capsular damage is still unknown, mechanical capsular damage via inadvertent posterior microtrauma by the injection, or even uncharacterized biochemical damage, has been mentioned as a potential cause. This evidence seems to suggest that the risk could be even higher for inexperienced surgeons and in patients with a history of more than ten injections [ 9 , 11 ].…”

Management of Cataract in Patients with Age-Related Macular Degeneration

“…Analysis considering intravitreal injections as a categorical variable identified 10 or more previous injections that were associated with a 2.6 times greater likelihood of PCR (p = 0.003) after adjusting for other significant independent predictors. Three independent studies have supported this observation, one from the USA, and two others from the UK [47][48][49]. Much like we see with COVID-19 vaccine development, rare adverse events can be identified outside of a clinical trial setting in real-world settings [50].…”