Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis after Cataract Surgery in the Elderly.
OBJECTIVE
To investigate the effect of prior intravitreal anti-vascular endothelial growth factor (VEGF) injections on surgical and postoperative complication rates associated with cataract surgery in a nationally representative longitudinal sample of elderly persons.


METHODS
Retrospective, longitudinal cohort analysis.


METHODS
A total of 203 643 Medicare beneficiaries who underwent cataract surgery from January 1, 2009, to December 31, 2013.


METHODS
By using the 5% sample of Medicare claims data, the study assessed risks of 3 adverse outcomes after receipt of cataract surgery for beneficiaries with a history of intravitreal injections. Risks of these outcomes in beneficiaries with a history of intravitreal injections relative to those without were calculated using the Cox proportional hazard model.


METHODS
The primary outcome was the risk of subsequent removal of retained lens fragments (RLFs) within 28 days after cataract surgery. Secondary outcomes were a new diagnosis of acute (<40 days) or delayed-onset (40+ days) endophthalmitis and risk of a new primary open-angle glaucoma (POAG) diagnosis within 365 days after cataract surgery.


RESULTS
Prior intravitreal anti-VEGF injections were associated with a significantly increased risk of subsequent RLF removal within 28 days after cataract surgery (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.19-4.30). Prior injections were also associated with increased risk of both acute (HR, 2.29; 95% CI, 1.001-5.22) and delayed-onset endophthalmitis (HR, 3.65; 95% CI, 1.65-8.05). Prior injections were not a significant indicator of increased risk of a new POAG diagnosis.


CONCLUSIONS
A history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications and endophthalmitis. Given the frequency of intravitreal injections and cataract surgery, increased preoperative assessment, additional intraoperative caution, and postoperative vigilance are recommended in patients with a history of intravitreal injections undergoing cataract extraction.
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Paul
P
Hahn
Department of Economics, Duke University, Durham, North Carolina.
Arseniy P
AP
Yashkin
Department of Economics, Duke University, Durham, North Carolina. Electronic address: fsloan@duke.edu.
Frank A
FA
Sloan
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D058449:Intravitreal Injections / Q000009:adverse effects*; D007906:Lens Subluxation / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A