Does Anti-VEGF Therapy Affect Cataract Surgery Complications?

Sophie J. Bakri, MD


May 31, 2016

Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis After Cataract Surgery in the Elderly

Hahn P, Yashkin AP, Sloan FA
Ophthalmology. 2016;123:309-315

Study Summary

Cataract surgery and anti-vascular endothelial growth factor (VEGF) injections are two of the most common ocular procedures performed in the elderly.

One of the most commonly asked questions by physicians and patients is whether the cataract surgery complication rate is higher in patients receiving anti-VEGF therapy. Theoretically, repeated anti-VEGF injections could weaken the lens zonules or cause damage to the posterior capsule, resulting in higher rates of retained lens fragments.

By using a 5% sample of a Medicare claims database, 203,643 Medicare beneficiaries' claims were examined for three outcomes: retained lens fragments, endophthalmitis, and risk for primary open-angle glaucoma (POAG).

The authors found that the risk for removal of retained lens fragments within 28 days of cataract surgery was increased in patients receiving intravitreal injections. Prior intravitreal injections also were associated with an increased risk for both acute and delayed-onset endophthalmitis but not a new diagnosis of POAG.


These data point to the need for increased vigilance in patients receiving intravitreal injections who undergo subsequent cataract surgery.

However, because the data are based on the Medicare claims database rather than an actual review of charts, there are some limitations. One limitation is that the database is unable to identify whether the cataract surgery and intravitreal injections occurred in the same eye.

In addition, the increased risk for endophthalmitis could be due to the risk inherent to intravitreal injections and not to an increased risk after cataract surgery.



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