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30 | EYEWORLD | JANUARY/FEBRUARY 2020 ASCRS NEWS eye was selected for analysis from patients who underwent bilateral cataract surgeries. Despite the study's weaknesses, its moder- ate sample size compared to the current liter- ature and findings make it a useful addition to the literature. Moreover, the results may allow physicians to improve preoperative counseling when explaining the risks of cataract surgery to patients with prior intravitreal injections and potentially allow for closer monitoring intra- operatively to help prevent posterior capsule rupture in these higher risk patients. It would be worthwhile to consider a meta-analysis of these studies or a multicenter study with sufficient sample size to power multivariate logistic re- gression analysis to better quantify the increased risk of PCR in patients who have received intravitreal injections. Editors' note: Supported in part by an unrestricted grant from Research to Prevent Blindness to New York University Langone Health Department of Ophthal- mology. Dr. Barger and Dr. Lidder contributed equally to this review. experienced trainees. It appears likely that the study was not sufficiently powered to identify such an association given that a similar larger study demonstrated a significantly increased incidence of PCR in less experienced grades of cataract surgeons. 8 The current study was pow- ered to identify a dose-dependent relationship of increasing PCR risk per intravitreal injection received (OR 1.086). However, the reported finding that the PCR rate was higher in patients with greater than 10 injections compared to those who received less than 10, as a grouped variable, does not appear to be statistically sig- nificant (p=0.18). Therefore, this interpretation should be evaluated with additional caution. This study and similar studies do not ad- dress the clinical centers' protocols for admin- istering anti-VEGF injections, which may relate to the future risk of PCR. Although the authors report guidelines including supine positioning of the patient and generally recommended distance from the limbus for injection of phakic eyes, it is unclear whether these recommenda- tions were followed. It is also unclear how one continued from page 28 References continued 7. Shalchi Z, et al. Risk of posteri- or capsule rupture during cataract surgery in eyes with previous intravitreal injections. Am J Oph- thalmol. 2017;177:77–80. 8. Lee AY, et al. Previous intravitreal therapy is asso- ciated with increased risk of posterior capsule rupture during cataract surgery. Ophthalmology. 2016;123:1252–6. 9. Khalifa YM, Pantanelli SM. Quiescent posterior capsule trauma after intravitreal injection: implications for the cataract surgeon. J Cataract Refract Surg. 2011;37:1364. 10. Saeed MU, Prasad S. Man- agement of cataract caused by inadvertent capsule penetration during intravitreal injection of ranibizumab. J Cataract Refract Surg. 2009;35:1857–9. Contact Sperber: Laurence.Sperber@nyulangone.org EXPERIENCE EYEWORLD 24/7 EyeWorld.org • Recent articles in web-friendly format • Searchable archives from 2007 to present • EyeWorld Weekly news feed • Trending videos • Live Twitter feed • CME and non-CME supplements • Links to all EyeWorld video sites

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