The role of surgical experience in posterior capsule rupture in eyes with prior intravitreal injections

PURPOSE: The aim of the study is to explore intraoperative challenges and complications during cataract surgery in patients with an intravitreal injection (IVI) history.
METHODS: This retrospective study included 119 eyes of patients who underwent cataract surgery following a history of IVIs at a tertiary center between January 2015 and October 2022. Data on demographics, number and type of injections, surgical technique, and intraoperative challenges and complications were collected. Surgeries were performed by either experienced surgeons or ophthalmology residents, and outcomes were compared accordingly.
RESULTS: Experienced surgeons exhibited lower complication rates compared to resident surgeons (odds ratio [OR], 5.68 p=0.06), highlighting the role of surgical expertise in minimizing complications during cataract surgery in patients with an IVI history. A moderate correlation was observed between the total number of prior IVIs and the complications during cataract surgery, suggesting a cumulative effect with multiple injections (> 10 IVIs, OR, 1.81). Dexamethasone injections were associated with higher rate of intraoperative difficulties (OR, 1.29, p=0.033). Posterior capsule rupture occurred in 9.2% of cases, with a higher incidence in cases performed by resident surgeons.
CONCLUSION: Cataract surgery in patients with a history of IVIs may present specific challenges, emphasizing the importance of surgical experience and individualized preoperative assessment. This study provides valuable insights for surgical decision-making and patient management in this specific population. Larger cohorts and further research are recommended to validate and extend these observations.

Keywords: Cataract surgery, complication, intravitreal injection, posterior capsule rupture, resident surgeon.