Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis after Cataract Surgery in the Elderly.
Abstract
PURPOSE: To investigate the effect of prior intravitreal anti-vascular endothelial
growth factor (VEGF) injections on surgical and postoperative complication rates associated
with cataract surgery in a nationally representative longitudinal sample of elderly
persons. DESIGN: Retrospective, longitudinal cohort analysis. PARTICIPANTS: A total
of 203 643 Medicare beneficiaries who underwent cataract surgery from January 1, 2009,
to December 31, 2013. METHODS: By using the 5% sample of Medicare claims data, the
study assessed risks of 3 adverse outcomes after receipt of cataract surgery for beneficiaries
with a history of intravitreal injections. Risks of these outcomes in beneficiaries
with a history of intravitreal injections relative to those without were calculated
using the Cox proportional hazard model. MAIN OUTCOME MEASURES: The primary outcome
was the risk of subsequent removal of retained lens fragments (RLFs) within 28 days
after cataract surgery. Secondary outcomes were a new diagnosis of acute (<40 days)
or delayed-onset (40+ days) endophthalmitis and risk of a new primary open-angle glaucoma
(POAG) diagnosis within 365 days after cataract surgery. RESULTS: Prior intravitreal
anti-VEGF injections were associated with a significantly increased risk of subsequent
RLF removal within 28 days after cataract surgery (hazard ratio [HR], 2.26; 95% confidence
interval [CI], 1.19-4.30). Prior injections were also associated with increased risk
of both acute (HR, 2.29; 95% CI, 1.001-5.22) and delayed-onset endophthalmitis (HR,
3.65; 95% CI, 1.65-8.05). Prior injections were not a significant indicator of increased
risk of a new POAG diagnosis. CONCLUSIONS: A history of intravitreal injections may
be a risk factor for cataract surgery-related intraoperative complications and endophthalmitis.
Given the frequency of intravitreal injections and cataract surgery, increased preoperative
assessment, additional intraoperative caution, and postoperative vigilance are recommended
in patients with a history of intravitreal injections undergoing cataract extraction.
Type
Journal articleSubject
AgedAged, 80 and over
Angiogenesis Inhibitors
Cataract Extraction
Endophthalmitis
Female
Follow-Up Studies
Glaucoma, Open-Angle
Humans
Incidence
Intraoperative Complications
Intravitreal Injections
Lens Subluxation
Male
Medicare
Retrospective Studies
Risk Factors
United States
Vascular Endothelial Growth Factor A
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https://hdl.handle.net/10161/14805Published Version (Please cite this version)
10.1016/j.ophtha.2015.06.040Publication Info
Hahn, Paul; Yashkin, Arseniy P; & Sloan, Frank A (2016). Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis
after Cataract Surgery in the Elderly. Ophthalmology, 123(2). pp. 309-315. 10.1016/j.ophtha.2015.06.040. Retrieved from https://hdl.handle.net/10161/14805.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Paul Hahn
Assistant Professor of Ophthalmology
I have been extensively involved in research throughout my academic career. While
an undergraduate at Harvard College, I studied various proteins at an ultrastructural
level towards rational design of novel drugs. During medical school at the University
of Pennsylvania, I continued with basic science research studying mechanisms of action
of nuclear receptors and optimizing protocols for gene therapy. I completed my PhD
at the University of Pennsylvania studying the role of iron overload
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Frank A. Sloan
J. Alexander McMahon Distinguished Professor Emeritus of Health Policy and Management
Professor Sloan is interested in studying the subjects of health policy and the economics
of aging, hospitals, health, pharmaceuticals, and substance abuse. He has received
funding from numerous research grants that he earned for studies of which he was the
principal investigator. His most recent grants were awarded by the Robert Wood Johnson
Foundation, the Center for Disease Control, the Pew Charitable Trust, and the National
Institute on Aging. Titles of his projects include, “Why Mature S
Arseniy Yashkin
Research Scientist, Senior
I am primarily a health outcomes researcher who specializes in cancers and chronic
age-related diseases, especially Alzheimer’s disease and type II diabetes mellitus. However,
I also write in epidemiology, demography, health economics and genetics. I am a specialist
in the analysis of administrative big health data. My main contributions to scholarship
can be summarized across three focus areas: health outcomes research, epidemiolog
Alphabetical list of authors with Scholars@Duke profiles.

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