title: Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery.
abstract: To investigate if previous intravitreal therapy is a predictor of posterior capsule rupture (PCR) during cataract surgery.
  
  
  
  Multicenter, national electronic medical record (EMR) database study with univariate and multivariate regression modeling.
  
  
  
  A total of 65 836 eyes of 44 635 patients undergoing cataract surgery.
  
  
  
  Anonymized data were extracted for eyes undergoing cataract surgery from 20 hospitals using the same EMR for cases performed between 2004 and 2014. Variables included as possible risk indicators for PCR were age, sex, number of previous intravitreal injections, indication for intravitreal therapy, grade of healthcare professional administering intravitreal therapy, advanced cataract, and cataract surgeon grade.
  
  
  
  Presence or absence of posterior capsular rupture during cataract surgery.
  
  
  
  Data were available on 65 836 cataract operations, of which 1935 had undergone previous intravitreal therapy (2.9%). In univariate regression analyses, patient age, advanced cataract, junior cataract surgeon grade, and number of previous intravitreal injections were significant predictors of PCR. By considering the number of previous intravitreal injections as a continuous variable, the odds ratio for PCR per intravitreal injection was 1.04 (P = 0.016) after adjusting for age, advanced cataract, and cataract surgeon grade. Repeat analysis considering intravitreal injections as a categoric variable showed 10 or more previous injections were associated with a 2.59 times higher likelihood of PCR (P = 0.003) after again adjusting for other significant independent predictors.
  
  
  
  Previous intravitreal therapy is associated with a higher likelihood of PCR during cataract surgery. This study provides data to help inform surgeons and patients about the risk of complications when undergoing cataract surgery after multiple prior intravitreal injections. Further investigation is required to determine the cause behind the increased PCR risk.
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; University of Washington, Department of Ophthalmology, Seattle, Washington.
authors.forename: Aaron Y
authors.initials: AY
authors.lastname: Lee
authors.affiliation: The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Bristol Eye Hospital, Bristol, United Kingdom.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Day
authors.affiliation: The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Egan
authors.affiliation: Bristol Eye Hospital, Bristol, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Johnston
authors.affiliation: Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Marie D
authors.initials: MD
authors.lastname: Tsaloumas
authors.affiliation: Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom.
authors.forename: Alastair K
authors.initials: AK
authors.lastname: Denniston
authors.affiliation: The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. Electronic address: adnan.tufail@moorfields.nhs.uk.
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D057286:Electronic Health Records; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D007903:Lens Capsule, Crystalline / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018918:Phacoemulsification / Q000009:adverse effects*; D057851:Posterior Capsular Rupture, Ocular / Q000209:etiology*; D012164:Retinal Diseases / Q000188:drug therapy; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014822:Vitreous Body / Q000187:drug effects*
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A