Anti-VEGF Injection History Heightens Risk of Cataract Surgery Complications

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New data reported at the 128th Annual American Academy of Ophthalmology (AAO) Meeting suggest that patients who previously received intravitreal anti-vascular endothelial growth factor (VEGF) injections may experience a greater risk of complications following cataract surgery.¹

In comparison with those who never received anti-VEGF treatment, treated eyes experienced a greater risk of non-clearing vitreous hemorrhage, retained lens fragments, retinal detachment, retinal tear, intraocular lens (IOL) dislocation, anterior vitrectomy, and glaucoma surgery.

“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,” said lead investigator Winnie Yu, Temerty Faculty of Medicine, University of Toronto.

Since first approval in 2006, treatment with anti-VEGF therapies has notably increased among patients with retinal diseases. These individuals, treated for conditions including age-related macular degeneration (AMD) and diabetic eye disease, are at an increased risk for cataract development given their age.

Current research is unclear on whether a history of multiple past eye injections can complication future cataract surgery, according to Yu and colleagues.

This analysis, using physician billing and diagnostic data from the Ontario Health Insurance Plan, sought to assess the risk level of cataract surgery complications in people who previously received intravitreal injections. A total of 163,663 patients with retinal conditions underwent cataract surgery between 2009 and 2018, of which 3243 received anti-VEGF therapy before cataract surgery.

Compared with patients who never received anti-VEGF therapy, individuals treated with anti-VEGF experienced a higher risk of complications, including non-clearing vitreous hemorrhage (adjusted hazard ratio [aHR], 3.37; 95% CI, 2.57–4.43), retained lens fragments (aHR, 2.00; 95% CI, 1.02–3.91), and retinal detachment (aHR, 3.63; 95% CI, 2.47–5.35).

Those treated with anti-VEGF injections also experienced a greater risk of 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), compared with non-anti-VEGF treated eyes.

However, Yu and colleagues did not identify an elevated risk of corneal transplants, intraocular lens (IOL) exchange, or IOL repositioning in individuals with a treatment history of anti-VEGF medications. Based on these findings, the team indicated a need to preoperatively counsel patients with retinal disease to discuss the potential risks of cataract surgery.

“Patients with prior intravitreal injection history should be counseled on the potential risks of cataract surgery to ensure appropriate informed surgical decision-making,” Yu added.

References

1. _{Yu W, Jin T, Muni RH, Kertes PJ, Popovic M. Cataract Surgery Complications in Individuals Who Previously Received Intravitreal Injections. Poster presented at American Academy of Ophthalmology (AAO) 2024 Meeting. Chicago, Illinois. October 18-21, 2024.}
2. _{AAO. Sight-saving eye injections may make Cataract Surg. Newswise. October 17, 2024. Accessed October 17, 2024. https://www.newswise.com/articles/sight-saving-eye-injections-may-make-cataract-surgery-more-risky#:~:text=Compared%20with%20patients%20who%20never,anterior%20vitrectomy%20and%20glaucoma%20surgery.}