Sight-saving Eye Injections May Make Cataract Surgery More Risky

The number of people treated with anti-VEGF medications has grown exponentially since these sight-saving medications were first approved in 2006. Many of these people, treated for conditions such as macular degeneration and diabetic eye disease, will inevitably develop a cataract, a common condition among aging adults. Based on current research, it’s unclear if a history of multiple past eye injections complicates future cataract surgery.

In the largest study to date, researchers in Canada analyzed data from a universal healthcare system and found that patients are at higher risk of multiple possible complications following cataract sugery. They will present their study this week at AAO 2024, the 128^th annual meeting of the American Academy of Ophthalmology.

Using physician billing and diagnostic from the Ontario Health Insurance Plan, the researchers identified 10 visually significant complication events due to cataract surgery and evaluated their associations with patients who had a history of treatment with intravitreal injections. A majority were treated with anti-VEGF medications.

Researchers identified 163,663 patients with retinal conditions who had undergone cataract surgery between 2009 and 2018. Of this group, 3,243 received anti-VEGF eye injections prior to cataract surgery.

Compared with patients who never received anti-VEGF treatments, 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.

• Non-clearing vitreous hemorrhage (aHR 3.37, 95% 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)

Researchers did not find an increased risk of corneal transplants, IOL exchange, or IOL repositioning in patients who had a history of treatment with anti-VEGF medications.

“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 researcher Winnie Yu of the University of Toronto Temerty Faculty of Medicine in Toronto, Ontario. “Patients with prior intravitreal injection history should be counselled on the potential risks of cataract surgery to ensure appropriate informed surgical decision-making.”

About the American Academy of Ophthalmology

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.