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

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2016-02

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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.

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10.1016/j.ophtha.2015.06.040

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Hahn, Paul, Arseniy P Yashkin and Frank A Sloan (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.

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Scholars@Duke

Yashkin

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, epidemiology and methodology, and health economics.  Some of my most important findings are described below.

Sloan

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 Smokers Do Not Quit,” “Legal and Economic Vulnerabilities of the Master Settlement Agreement,” “Determinants and Cost of Alcohol Abuse Among the Elderly and Near-elderly,” and “Reinsurance Markets and Public Policy.” He received the Investigator Award for his work on the project, “Reoccurring Crises in Medical Malpractice.” Some of his earlier works include the studies entitled, “Policies to Attract Nurses to Underserved Areas,” “The Impact of National Economic Conditions on the Health Care of the Poor-Access,” and “Analysis of Physician Price and Output Decisions.” Professor Sloan’s latest research continues to investigate the trends and repercussions of medical malpractice, physician behavior, and hospital behavior.


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