Management And Outcome Of Cataract Surgery After Suspected Or Confirmed Lens Touch Following Intravitreal Injections

Intravitreal injections (IVIs) have been associated with increased risk of posterior capsular rupture (PCR) during subsequent cataract surgery, yet surgical outcomes in eyes with suspected or confirmed injection-related lens touch remained poorly described and largely limited to case reports and small case series. Our study aims to evaluate the surgical management and outcomes of cataract surgery in eyes with suspected or confirmed lens touch following IVIs.

Retrospective case series conducted at London North West University Healthcare NHS Trust, United Kingdom, between 2021 and 2025.

Medical records were retrospectively reviewed for 22 eyes of 22 patients who underwent cataract surgery between 2021 and 2025 following suspected or confirmed lens touch during IVI. Lens touch was classified as confirmed when needle–lens/capsule injury or definite capsular defect was documented, and as suspected when there was a sudden significant decline in vision following IVI in the absence of other complications defined as ≥0.3 logMAR decrease. Outcomes assessed included surgical approach, intraoperative events, intraocular lens (IOL) position, postoperative complications, mean change in visual acuity, and best-corrected visual acuity (BCVA, logMAR) at 2–6 weeks, 3 months and 6 months.

Twenty-two eyes (11 confirmed, 11 suspected lens touch) were included in the analysis. IVI indications were age-related macular degeneration (AMD) 40.9%, diabetic maculopathy 40.9% and retinal vein occlusion (RVO) 13.6%. Phacoemulsification alone was performed in 63.6%, while 36.4% required combined surgery (anterior vitrectomy 18.2%, pars plana vitrectomy 18.2%). Posterior capsule rupture occurred in 13.6%. IOL placement was in-the-bag in 72.7%, ciliary sulcus in 22.7%, anterior chamber IOL in 4.5%. Mean BCVA improved from 1.55 to 0.33 (2–6 weeks) and 0.36 (6 months). Post-operative macular oedema was documented in 45.5%, and IOL repositioning in 4.5%.

Cataract surgery following suspected or confirmed IVI-associated lens touch achieved meaningful visual recovery and in most cases was managed with phacoemulsification alone. A third of cases required vitrectomy and/or non-bag IOL fixation, highlighting the importance of pre-operative counselling and preparedness for potential capsular compromise with vitreoretinal support available. Post-operative macular oedema was predominantly seen in diabetic eye disease and retinal vein occlusion, underscoring the need for coordinated retinal follow-up in these patients. FINANCIAL DISCLOSURE: None