Posterior capsular rupture during cataract surgery in eyes treated previously with intravitreal injections

Introduction:
Intravitreal injections are currently the most common intraocular surgical procedure worldwide.
Some studies have reported a higher risk of intraoperative complications, namely posterior capsular rupture (PCR), during cataract surgery.
The aim of this retrospective and observational study, conducted at Department of Ophthalmology, Centro Hospitalar Universitário do Porto, was to assess the risk of posterior capsular rupture (PCR) during cataract surgery in eyes previously treated with intravitreal injections (IVI) with antivascular endothelial growth factor (anti-VEGF) and/or corticosteroids.
Methods: 
Eyes undergoing cataract surgery between June 2019 and May 2021. Combined surgeries, such as glaucoma surgery and pars plana vitrectomy (PPV) were excluded. The occurrence of PCR during cataract surgery in treated and previously untreated eyes with IVI was analyzed.
Results:
A total of 5813 cataract surgeries were analyzed; 4.1% of the cases had previously undergone IVI. The PCR rate in cataract surgery was 1.8%: 6.7% in eyes previously treated with IVI and 1.6% without previous IVI (OR=4.5, 95% CI: 2.6-7.7, p<0.001). 
The combined therapy (anti-VEGF with corticosteroids) presents a higher risk compared to the two therapies alone as monotherapy (OR=11.6, 95% CI: 4.7-28.5, p<0.001), as well as treated eyes treated with ≥10 IVI (OR=2.1, 95% CI: 0.8-6.1, p=0.144) and a time interval between the last IVI and cataract surgery was ≤6 months (OR=1.9, 95% CI: 0.6-6.1, p=0.296). 
Discussion/Conclusion:
These results demonstrate that eyes that require IV treatment prior to cataract surgery are at increased risk of CPA during cataract surgery, and careful assessment of the characteristics of the cataract and posterior capsule is critical.