Intravitreal injections for AMD and DME may complicate cataract surgery

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A press release from the American Academy of Ophthalmology (AAO) reports that a new study found that treatment with intravitreal anti-vascular endothelial growth factor (VEGF) injections for age-related macular degeneration (AMD) and diabetic macular edema (DME) may result in a higher risk of complications after subsequent cataract surgeries.

The study results will be reported at the 2024 AAO annual meeting in Chicago.

Intravitreal therapy for these retinal conditions was introduced almost 2 decades ago. According to the press release, “Based on current research, it was unclear if a history of multiple past eye injections complicates future cataract surgery.”

A large study performed in Canada analyzed data from the Ontario Health Insurance Plan, a universal healthcare system, and found that patients are at higher risk of multiple possible complications after cataract surgery.

The investigators, led by lead researcher Winnie Yu, MSc of the University of Toronto Temerty Faculty of Medicine in Toronto, Ontario, identified 10 visually significant complications due to cataract surgery and evaluated their associations with patients who had a history of treatment with intravitreal injections. Most patients were treated with anti-VEGF medications.

The study found 163,663 patients with retinal conditions who had undergone cataract surgery between 2009 and 2018, of whom 3,243 were treated with anti-VEGF intravitreal injections before cataract surgery.

The press release noted that “treated patients had a higher risk of non-clearing vitreous hemorrhage, retained lens fragments, retinal detachment, retinal tear, intraocular lens (IOL) dislocation, anterior vitrectomy, and glaucoma surgery.”

The following data were released:

• Non-clearing vitreous hemorrhage (average hazard ratio [aHR], 3.37; 95% confidence interval [CI], 2.57–4.43)
• Retained lens fragments (aHR 2.00; 95% CI, 1.02–3.91)
• Retinal detachment (aHR 3.63; 95% CI ,2.47–5.35)
• Retinal tear (aHR 3.24; 95% CI, 2.36- 4.45)
• IOL dislocation (aHR 1.97; 95% CI, 1.31–2.97)
• Anterior vitrectomy (aHR 1.67; 95% CI, 1.17–2.38) and
• Glaucoma surgery (aHR 4.03; 95% CI, 2.86–5.70)

Ms. Yu and colleagues did not identify an increased risk of corneal transplants, IOL exchange, or IOL repositioning in the patients treated with anti-VEGF medications.

She commented, “The findings of this study highlight the importance of preoperative and intraoperative surgical planning in the prevention and management of these possible complications in patients receiving cataract surgery. Patients with a prior intravitreal injection history should be counselled on the potential risks of cataract surgery to ensure appropriate informed surgical decision-making.”