Risk of Cataract Surgery Complications in Patients with Prior Intravitreal Injection Therapy.

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To compare the rate of cataract surgery complications in patients with and without prior intravitreal injection (IVI) pharmacotherapy. A retrospective cohort study was performed using the TriNetX (Cambridge, MA) aggregated electronic health records research network. Patients with a history of IVI therapy within twenty years of cataract surgery were compared to a control group using propensity score matching (PSM) to balance for baseline demographics, systemic, and ocular co-morbidities. Patients with a history of lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded. IVI therapy within twenty years of cataract surgery. Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), need for a secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery. Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI, 1.16-1.54; p<0.0005) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI, 1.27-2.66; p=0.001) and 90 days (RR 2.05; 95% CI, 1.65-2.54; p<0.0005). No other complications were associated with IVI. In particular, IVI was not associated with higher rates of anterior vitrectomy except in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI, 0.85-1.79; p=0.001). Patients with DR and prior IVI had a higher risk of lensectomy, RD repair, and secondary procedures (p < 0.0005 for all) compared to DR patients without prior IVI. Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.