First Author: Z.Shalchi UK
Co Author(s): R. Hamilton
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We have recently shown increased posterior capsule rupture (PCR) rates during cataract surgery in eyes with prior intravitreal injections. The cause for this increased risk is unclear. We wanted to investigate the nature of PCR in these cases.
Moorfields Eye Hospital (main and satellite sites)
We used the Moorfields Patient Administrative System (PAS) and OpenEyes electronic databases to identify all cataract surgery procedure undertaken in the Medical Retina service between 1 April 2013 and 31 August 2016. Procedures complicated by PCR were identified and note was made of prior occurrence of intravitreal injection. The operation note for each case was scrutinised, as well as the postoperative course. Each PCR in an injected eye was linked to 2 PCR cases in non-injected eyes that acted as age- and sex-matched controls. Early PCR was defined as occurring before completion of phacoemulsification nucleus removal, with late PCR after this step.
In total, 63,147 cataract surgery procedures were undertaken over the study period, of which 5,711 (9.07%) were in the Medical Retina service. PCR occurred in 97 (1.70%) of these cases, of which 11 had prior intravitreal injection. The surgery was performed by a consultant (senior) surgeon in 4 (36%) of 11 injected eyes and 9 (41%) of 22 non-injected eyes (Chi-square=0.063, p=0.80). In the injected group, early PCR occurred in 6 (75%) of 8 cases where this information was available. In control cases, early PCR occurred in 11 (61%) of 18 procedures (Chi-square=0.472, p=0.49). Postoperative vitrectomy and nucleus fragmentation was needed in 2 of 11 (18%) injected eyes and 2 of 22 (9%) non-injected eyes (Chi-square=0.266, p=0.61). In both groups, 9% of eyes developed postoperative rhegmatogenous retinal detachment.
PCR occurs both early and late during cataract surgery in injected and non-injected eyes and the timing of this complication is not related to prior intravitreal injection.