Previous intravitreal injection as a risk factor of posterior capsule rupture in cataract surgery: a systematic review and meta‐analysis

Abstract

Purpose Intravitreal injections and cataract surgery are two common procedures in the elderly. Posterior capsular rupture (PCR) is a rare but important complication of cataract surgery. We systematically reviewed the literature on previous intravitreal injections as a risk factor of PCR and performed meta‐analyses to provide pooled summary risk estimates. Methods We searched 13 literature databases on 1 June 2021 for studies evaluating the risk of PCR in eyes undergoing cataract surgery with data on previous intravitreal injections. Data extraction was made independently by two authors and discussed afterwards until reaching consensus. Random effects meta‐analyses on the pooled odds ratio (OR) of PCR in eyes with previous intravitreal injections were made using MetaXL 5.3. Results Six studies on 1 051 097 eyes undergoing cataract surgery were eligible for the qualitative and quantitative review. Previous history of intravitreal injections was present in 7034 eyes (majority was anti‐VEGF). Our meta‐analyses revealed that any previous intravitreal injection was a risk factor for PCR with an OR of 2.30 (95% CI 1.39–3.81). For each previous intravitreal injection, the risk of PCR was OR 1.04 (95% CI 1.01–1.08) (equivalent of relative risk ~1.04). In other words, risk of PCR increases by 4% for each previous intravitreal injection. Conclusions Previous intravitreal injection is a risk factor for PCR and should be taken into account when planning cataract surgery. However, to be regarded as a clinically significant risk of PCR, a substantial number of previous intravitreal injection (e.g. ≥10) should have been administered, considering that the a priori risk of PCR is very low (~1%).

Intraoperative complications and visual outcomes of cataract surgery in neovascular age-related macular degeneration

“…Another possibility is the inadvertent iatrogenic trauma to the zonular fibers at the time of injection leading to capsular instability at the time of cataract surgery, possibly increasing the risk for PCR. 11,15,16 However, we observed a similar rate of dropped lens fragments and zonular dialysis between the NvAMD and the reference groups (0.46% vs 0.29% and 0.46% vs 0.58%, respectively).…”

Development of machine learning models to predict posterior capsule rupture based on the EUREQUO registry

“…Moreover, we were limited to the features that are recorded in the EUREQUO. Other features that might be relevant for the prediction of PCR likely exist, such as the axial length (Day et al, 2015), intake of a1‐adrenergic receptor antagonists and other medication that could lead to intraoperative floppy iris syndrome (Christou et al, 2022), or whether the patient received previous intravitreal injections (Bjerager et al, 2022). Future research could study whether the addition of such features improves performance.…”

Ten‐year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register

“…Increasing age, pseudoexfoliation syndrome (Hayashi et al, 2013), glaucoma, endothelial dystrophy with cornea guttata (Viberg et al, 2020), age‐related macular degeneration (Chu et al, 2016) and diabetic retinopathy are known risk factors, for example poorer result (Cao et al, 2013; Grimfors et al, 2014), posterior capsule rupture (Chakrabarti & Nazm, 2017), corneal edema, and macular edema. There is no information in the NCR about other potential risk factors for PCR like previous intravitreal injection (Bjerager et al, 2022) or posterior polar cataract (Chan et al, 2014). The difference between the groups is therefore arguable and the percentage of ISBCS in cases with ocular comorbidity should perhaps be even lower, Table 2.…”