Eyeworld

28 | EYEWORLD | JANUARY/FEBRUARY 2020 ASCRS NEWS limits the current study's statistical power, which certainly could influence the reported higher rates of PCR compared to the larger studies. Nagar et al. did not observe a statistical- ly significant difference in the rate of PCR based on the grade of the operating surgeon, although it is unclear whether this finding was in reference to the clinician administering the intravitreal injection versus performing the cataract surgery. While it is likely the authors were referring to the surgeon performing the surgery, this distinction should ideally be clar- ified particularly due to the authors' proposed mechanism of trauma during the intravitreal injection as a means to disrupt the posterior capsule or cause inadvertent zonular trauma, which theoretically would be more likely in less a significant predictor of PCR. 8 It is possible that there may have been a disparate number of patients in this study's intravitreal injection group with higher grade cataracts, which would artificially increase the PCR rate. The authors also did not exclude other groups at high risk for posterior capsule compromise such as those with prior trauma, prior intraocular surgery, pseudoexfoliation syndrome, or Marfan syn- drome. Similarly, it is possible that other vari- ables such as increased age may independently relate to a higher risk of PCR; this study's popu- lation of patients who had received intravitreal anti-VEGF injections was approximately 2 years older than those patients who had not received injections, which approached statistical signifi- cance (p=0.053). It seems likely that the relative- ly lower sample size compared to prior studies continued from page 27 References 1. Nagar AM, et al. The risk of posterior capsular rupture during phacoemulsification cataract surgery in eyes with previous intravitreal anti-vascular endo- thelial growth factor injections. J Cataract Refract Surg. 2020;46. Article in press. 2. Diabetic Retinopathy Clinical Research Network, Elman MJ, al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology. 2012;119:2312–8. 3. Brown DM, et al. Ranibizumab versus verteporfin for neo- vascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44. 4. Rosenfeld PJ, al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31. 5. Brown DM, et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology. 2011;118:1594– 602. 6. Boyer D, et al. Vascular en- dothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmolo- gy. 2012;119:1024–32. continued on page 30 The risk of posterior capsule rupture during phacoemulsification cataract surgery in eyes with previous intravitreal anti-vascular endothelial growth factor injections Anindyt Nagar, MBBS, Joshua Luis, MBBS, Nimrath Kainth, Georgios Panos, MD(Res), Cordelia Mckechnie, MBBS, Sudeshna Patra, MBBS J Cataract Refract Surg. 2020;46(2). Article in press. n Results: Data was available for 4047 cataract operations. Of these, 108 had undergone previous anti-VEGF IVI treatment. Three eyes were noted to have preoperative PC trauma and were excluded from the final analysis. The logistic regression analysis after exclusion of the eyes with pre-existing damage to the PC confirmed that prior anti-VEGF IVI treatment was associated with an increased risk of PCR when compared to the non-IVI group (9.26% vs 1.88%, p<0.0001). There is a dose dependent relationship between the number of anti-VEGF injections and the likelihood of PCR. n Conclusions: Previous intravitreal anti-VEGF injections are significantly correlated with an increased risk of surgical PCR despite the absence of visible structural damage to the PC preoperatively. n Purpose: To investigate if previous intravitreal anti-vascular endothelial growth factor (VEGF) injections are a predictor for posterior capsule rupture (PCR) during phacoemulsification cataract surgery. n Setting: National Health Service: Whipps Cross University Hospital Eye Treatment Centre. District General, London, United Kingdom n Design: Single center, retrospective, electronic medical record (EMR) database study with univariate analysis. n Methods: EMR (Medisoft) was used to extract data for eyes undergoing phacoemulsification surgery between 01.08.16 and 01.01.18. Patient demographics, indication for intravitreal therapy, treatment type, number of previous intravitreal injections (IVI), diabetic status, surgeon grade and operative complications were included as variables for analysis.

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