Cataract Surgery For Patients Receiving Intravitreal Injections: A Surgeon's Perspective

There is growing literature on the increased risk of intraoperative and post operative complications in the setting of cataract surgery on eyes that have previously received intravitreal anti vascular endothelial growth factors (Anti- VEGF). This includes increased risk of posterior capsule rupture, retained lens fragments and acute endophthalmitis. With the growing patient population receiving intravitreal injections, this will be encountered more frequently by the cataract surgeon. In this survey, we aimed to capture surgeon’s perspective on dealing with cataract surgery in patients that have previously received intravitreal injections and capture variations in practice.

A survey of cataract surgeons in a tertiary teaching hospital in the United Kingdom.

The survey was sent to all cataract surgeons in a tertiary teaching hospital in the United Kingdom. The cataract surgeons were asked on their current practice when assessing and preforming cataract surgery on patients that have previously received intra-vitreal injections.

A total of 20 respondents returned their surveys of which 55% were consultants and 45% specialty or resident doctors. 10.0% of respondents reported that a history of a patient receiving intravitreal injections would routinely change their usual surgical technique while preforming phacoemulsification. This included avoiding hydrodissection, alternative technique for nucleus removal, avoiding rotation of nucleus and some surgeons reported that they would treat these cases like a posterior polar cataract. 15.0 % of surgeons would suture the main incision, 45.0% would not and 40.0% only if the patient is going receive intravitreal injections within a specific time frame (range 1 -4 weeks post operatively).

In our survey, the main variation in practice was some surgeons would advocate suturing the main wound following cataract surgery if the patient is going to receive further intravitreal injections post operatively. Further research on whether suturing the main wound following cataract surgery would decrease the risk of post opertaive endophthalmitis is needed. The risk of posterior capsular rupture in these cases is also increased. However, this was not reflected in a routine change in clinical practice as reflected in the results of our survey.