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

dc.contributor.author

Hahn, Paul

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Yashkin, Arseniy P

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Sloan, Frank A

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United States

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2017-06-05T17:52:59Z

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2017-06-05T17:52:59Z

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2016-02

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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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https://www.ncbi.nlm.nih.gov/pubmed/26278863

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S0161-6420(15)00652-1

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1549-4713

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https://hdl.handle.net/10161/14805

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eng

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Elsevier BV

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Ophthalmology

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10.1016/j.ophtha.2015.06.040

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Aged

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Aged, 80 and over

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Angiogenesis Inhibitors

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Cataract Extraction

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Endophthalmitis

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Female

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Follow-Up Studies

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Glaucoma, Open-Angle

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Humans

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Incidence

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Intraoperative Complications

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Intravitreal Injections

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Lens Subluxation

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Male

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Medicare

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Retrospective Studies

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Risk Factors

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United States

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Vascular Endothelial Growth Factor A

dc.title

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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Journal article

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Yashkin, Arseniy P|0000-0002-1185-148X

pubs.author-url

https://www.ncbi.nlm.nih.gov/pubmed/26278863

pubs.begin-page

309

pubs.end-page

315

pubs.issue

2

pubs.organisational-group

Center for Child and Family Policy

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Center for Population Health & Aging

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Duke

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Duke Population Research Center

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Duke Population Research Institute

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Economics

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Faculty

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Nursing

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Sanford

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Sanford School of Public Policy

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School of Nursing

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Staff

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Trinity College of Arts & Sciences

pubs.publication-status

Published

pubs.volume

123

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