Previous Intravitreal Therapy Is Associated with Increased Risk of Posterior Capsule Rupture during Cataract Surgery

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• 作者：Aaron Y. Lee ; MD ; MSCI¹ ; ² ; Alexander C. Day ; PhD ; FRCOphth³ ; ⁴ ; Catherine Egan ; FRANZCO³ ; Clare Bailey ; FRCOphth⁴ ; Robert L. Johnston ; FRCOphth⁵ ; Marie D. Tsaloumas ; FRCOphth⁶ ; Alastair K. Denniston ; FRCOphth ; PhD⁶ ; ⁷ ; Adnan Tufail ; MD ; FRCOphth³ ; ^{adnan.tufail@moorfields.nhs.uk" class="auth_mail" title="E-mail the corresponding author} ; for the United Kingdom Age-related Macular Degeneration ; Diabetic Retinopathy Electronic Medical Records Users Group^&lowast ; ; Toks Akerele ; Saher Al-Husainy ; Christopher Brand ; Usha Chakravarthy ; Louise Downey ; Alan Fitt ; Rehna Khan ; Vineeth Kumar ; Aires Lobo ; Sajjad Mahmood ; Kaveri Mandal ; Martin McKibbin ; Geeta Menon ; Salim Natha ; Jong Min Ong ; Atul Varma ; Elizabeth Wilkinson
• 关键词：AMD ; age-related macular degeneration ; CI ; confidence interval ; DR ; diabetic retinopathy ; EMR ; electronic medical records ; OR ; odds ratio ; PCR ; posterior capsule rupture ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：123
• 期：6
• 页码：1252-1256
• 全文大小：285 K

文摘

To investigate if previous intravitreal therapy is a predictor of posterior capsule rupture (PCR) during cataract surgery.

Design

Multicenter, national electronic medical record (EMR) database study with univariate and multivariate regression modeling.

Participants

A total of 65 836 eyes of 44 635 patients undergoing cataract surgery.

Methods

Anonymized data were extracted for eyes undergoing cataract surgery from 20 hospitals using the same EMR for cases performed between 2004 and 2014. Variables included as possible risk indicators for PCR were age, sex, number of previous intravitreal injections, indication for intravitreal therapy, grade of healthcare professional administering intravitreal therapy, advanced cataract, and cataract surgeon grade.

Main Outcome Measures

Presence or absence of posterior capsular rupture during cataract surgery.

Results

Data were available on 65 836 cataract operations, of which 1935 had undergone previous intravitreal therapy (2.9%). In univariate regression analyses, patient age, advanced cataract, junior cataract surgeon grade, and number of previous intravitreal injections were significant predictors of PCR. By considering the number of previous intravitreal injections as a continuous variable, the odds ratio for PCR per intravitreal injection was 1.04 (P = 0.016) after adjusting for age, advanced cataract, and cataract surgeon grade. Repeat analysis considering intravitreal injections as a categoric variable showed 10 or more previous injections were associated with a 2.59 times higher likelihood of PCR (P = 0.003) after again adjusting for other significant independent predictors.

Conclusions

Previous intravitreal therapy is associated with a higher likelihood of PCR during cataract surgery. This study provides data to help inform surgeons and patients about the risk of complications when undergoing cataract surgery after multiple prior intravitreal injections. Further investigation is required to determine the cause behind the increased PCR risk.