Cataract surgery complications in individuals who previously received intravitreal injections: a population-based cohort analysis

Theme: Cataract surgery*
What: Cataract surgery
Part of: Cataract II: Anterior segment surgery for the cataract surgeon / Cataracte II - Chirurgie du segment antérieur pour le chirurgien spécialiste de la cataracte
When: 6/1/2024, 04:15 PM - 05:45 PM
Where: Room | Salle 801

Abstract

Purpose: To determine whether there are differences in the risk of cataract surgery complications in patients with retinal disease who have previously received intravitreal injections (IVI) compared to patients who have not previously received IVI. 

Study Design: Population-based cohort study using health administrative data within a public, universal health care system.

Methods: Using physician billing data from the Ontario Health Insurance Plan (OHIP) for the population of Ontario, Canada, we identified adults (age ≥20 years) with retinal disease (ICD-9 codes 362 and 250) who underwent cataract surgery between January 1, 2009 to December 31, 2018. Cataract surgery was identified from records submitted by ophthalmologists with ICD-9 code 366 and fee code E140. IVI records were identified by OHIP fee codes E147 and E149. Patients who received bilateral IVI treatments (i.e. two IVI OHIP records within 20 days) prior to cataract surgery were considered the exposure group, whereas patients with retinal disease and no prior record of IVI were considered the unexposed group. Patients with unilateral IVI treatment were excluded. Patients were followed up to 2 years following cataract surgery to determine the risk of the following complications: non-clearing vitreous hemorrhage, retained lens fragments and retinal tear. Adjusted hazards ratio (aHR) with 95% confidence intervals (CI) were derived from the multivariable Cox proportional hazards regression model. Covariates in the model included age, sex, neighborhood income quintile, rurality and history of glaucoma and keratitis.

Results: There were 428,007 adults identified in our cohort with retinal disease who received cataract surgery. Of those, 6,635 were included in the exposed group and 421,372 in the unexposed group. The majority were female (54.4%) and 65 years of age or older (78.4%). There were 1,483 patients with non-clearing vitreous hemorrhage, 384 with retained lens fragments and 1,209 with retinal tears post-cataract surgery. Patients with a previous history of IVI had a significantly greater risk of cataract surgery complications of non-clearing vitreous hemorrhage (aHR 3.86, 95% CI 3.12–4.78, p<.0001), retained lens fragments (aHR 2.05, 95% CI 1.18–3.57, p=0.0113) and retinal tear (aHR 3.42, 95% CI 2.67–4.39, p<.0001) when compared to individuals without a history of IVI.

Conclusions: This population-based cohort study revealed that cataract surgery patients with retinal disease who previously received IVIs were more likely to have post-cataract surgery complications of non-clearing vitreous hemorrhage, retained lens fragments and retinal tear. These findings should be considered in the pre-operative counselling of cataract patients.

Presenter(s)

Presenting Author: Winnie Yu

Additional Author(s):

Ya-Ping Jin, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada

Rajeev Muni, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/ Unity Health Toronto, Toronto, Ontario, Canada

Peter Kertes, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Marko Popovic, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada

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