Study investigates PCR risks associated with intravitreal injections for AMD

Posterior capsular rupture (PCR) is the most frequent complication during cataract surgery in patients treated previously with intravitreal anti-vascular endothelial growth factor (VEGF) injections for age-related macular degeneration (AMD), according to Dr Marta Belmonte-Grau.

During a presentation at the EURETINA 2021 Virtual Congress, Belmonte-Grau reported that this was especially true for patients with a posterior subcapsular cataract and likely the result of needle-induced trauma to the posterior capsule during injection. Belmonte-Grau is from the Hospital Universitario de la Princesa, Madrid.

Belmonte-Grau and her colleagues retrospectively reviewed the charts of patients undergoing phacoemulsification at their institution.

They evaluated patient age, gender, operated eye, presence of risk factors for surgical complications, duration of intravitreal treatment (≤6 or >6 months), number of preoperative intravitreal injections (≤10 or >10), surgeon experience (≤5 or >5 years), and initial/final visual acuity (VA). All patients had received previous anti-VEGF injections for AMD. The primary outcome measure was the occurrence of intraoperative PCR.

A total of 550 cataract surgeries were reviewed, with 83 eyes (15.09%; 57 women, 26 men; mean age, 84.52 years) having received previous intravitreal injections.

The investigators identified 20 eyes with a posterior subcapsular cataract (24.10%), 3 eyes (3.60%) with poor dilation, 2 eyes (2.40%) with mature cataract, and 1 eye (1.20%) with pseudoexfoliation syndrome.

“Patients with posterior subcapsular cataract had an odds ratio of 5.67 (95% confidence interval [CI], 5.67-5.67; p<0.05) for occurrence of an intraoperative complication,” investigators reported. “Regarding the complication rate, complications developed in 10 eyes (12.05%) during cataract surgery. The most frequent cause was dislocation of the nucleus into the vitreous (n=5, 6%) followed by PCR (n=3, 3.60%) and zonular disinsertion (n=2, 2.40%).”

Univariate analysis showed increased VA 6 months postoperatively (mean gain, 0.43 line). Surgeon experience and number of previous intravitreal injections were not significant risk factors for PCR.

With cataract surgery the most frequently performed surgery and the aging of the population, elderly women are the typical patients treated with intravitreal injections for AMD, Belmonte-Grau explained.

“PCR occurs more frequently during cataract surgery in patients who were treated previously with intravitreal injections and especially those with a posterior subcapsular cataract, probably caused by needle-induced trauma to the posterior capsule during injection,” she concluded. “We emphasize thorough evaluation of the cataract preoperatively in these patients. A large majority of the complications had to be treated with vitrectomy, so this eventuality must be included in the informed consent and the information provided to patients.”

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