Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Nonarteritic anterior ischemic optic neuropathy (NAION) has been reported to occur after cataract surgery. It is not clearly established whether cataract surgery increases the risk of NAION over baseline. Evidence Acquisition: Medline, PubMed, Embase, and Cochrane Central registers were systematically searched for eligible studies reporting on postcataract surgery NAION (psNAION) within 1 year. All peer-reviewed publications with events n $ 10 were included. Pooled incidence and odds/hazard ratios and 95% confidence intervals (CIs) were extracted and calculated using random effect models for early and delayed psNAION. Time to event data were pooled for temporal analysis of psNAION events within the first year. This systematic review was registered (PROS-PERO CRD42021274383). Results: Nine articles met the selection criteria with five studies suitable for meta-analysis. A total of 320 psNAION cases, 1,307 spontaneous NAION (sNAION) cases, 1,587,691 cataract surgeries, and 1,538,897 noncataract surgery controls were included. Pooling of 63,823 cataract surgeries and 161,643 controls showed a hazard ratio of 4.6 (95% CI 2.7-7.8) of psNAION within 1 year of surgery. Pooled unadjusted incidence of psNAION within 2 months was ) per 100,000/year, psNAION within 1 year was 32.36 (95% CI 9.38-55.34) per 100,000/year, and sNAION was 8.87 (95% CI 2.12-15.62) per 100,000/ year. psNAION cases were older by a mean of 7.6 years; otherwise, pooled odds ratios for baseline risk factors in psNAION vs. sNAION cases were not statistically significant. psNAION within the first year peaked within 72 hrs and at 6 weeks after the surgery with 73% of cases occurring within 6 months. Conclusion:The risk of NAION after cataract surgery is four times greater within the first year and usually occurs within 6 months. However, the absolute risk remains low at 1 in 1,000-3,100 surgeries and is unlikely to warrant extra mention for consenting.

Nanocarriers for the Delivery of Neuroprotective Agents in the Treatment of Ocular Neurodegenerative Diseases

“…Aspirin, VEGF inhibitors, and systemic corticosteroids are among the treatments for AION. The outcomes are contradictory, and other therapeutic approaches are required [ 115 , 116 ].…”

Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery: A Systematic Review and Meta-Analysis

“…Their meta-analysis of 3 studies determined that patients who underwent cataract surgery were 4.59 times more likely to have NAION compared with untreated counterparts, at 1 year postoperatively. 1 Moreover, they found nonsignificant differences in vascular risk factors between patients with pcsNAION and sNAION. 1 These results provide evidence for an important risk factor that has historically been a notable matter of debate.…”

“…1 Moreover, they found nonsignificant differences in vascular risk factors between patients with pcsNAION and sNAION. 1 These results provide evidence for an important risk factor that has historically been a notable matter of debate. 2 We humbly wish to state a few points for further discussion.…”

“…Interestingly, our analysis found that the pcsNAION group had significantly fewer cumulative systemic factors compared with the sNAION group. Notably, Shew et al 1 (2022) found nonsignificant differences in systemic factors between pcsNAION and sNAION groups. Our findings support this notion, and we expect that the development of pcsNAION is dependent on a combination of systemic risk factors and perioperative factors and perioperative risk factors likely lower the threshold for NAION in patients who are otherwise predisposed.…”

“…We read with great interest the article by Shew et al 1 (2022) entitled Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery: A Systematic Review and Meta-Analysis. Their systematic review included 9 comparative studies comparing the incidence of nonarteritic anterior ischemic optic neuropathy (NAION) after cataract surgery (pcsNAION) with spontaneous NAION (sNAION).…”