Rates of Posterior Capsular Rupture in Ophthalmology Resident Cases after Intravitreal Injections
Investigative ophthalmology & visual science
Purpose : It has been documented that intravitreal injections (IVI) can increase the rate of posterior capsular ruptures (PCR) during cataract surgery, however this has not been studied in resident cases. This study seeks to investigate PCR rates and potential risk factors for PCR in resident cases.
Methods : A retrospective consecutive cohort study was performed on patients of Beaumont Health, Royal Oak, Michigan. This study was done with the approval of the Institutional Review Board and with the standards delineated in the Helsinki Declaration. Using appropriate ICD-10 and CPT codes, a patient list was generated. Inclusion criteria included prior Beaumont Eye Institute patients 50 years of age or older, had prior history of IVI administered by a resident physician and had an intraoperative complication of PCR. Exclusion criteria included no other intraocular surgery for 3 months prior to the cataract surgery and no patient less than 50 years. Cataract surgery (CEIOL) was performed by third year ophthalmology residents. Data were analyzed using Chi-square analysis, Student t-test, and Relative Risk Ratio with GraphPad Prism. Statistical significance was set at p<0.05.
Results : 1,013 eyes were examined in this study of which 46 had PCR as an intraoperative complication of CEIOL (4.53%). Patients with prior IVI had 2.56 times the risk of developing PCR than patients with no history of IVI (RR=2.56, 95% CI=1.066-5.775; p=0.035). In the cohort with a PCR event, 10.87% had prior IVIs. Mean age for PCR complication was higher (68.33yrs, SD: 9.9) than the no PCR cohort (65.45yrs, SD 11.45); p=0.032. There was no significant relationship found between gender, laterality, prior retina surgery, or diagnosis for injection and PCR incidence.
Conclusions : Rates of PCR in resident cases of 4.53% is within the reported range of 0.5-16%. In attending cases without IVI the PCR rate is 0.45-3.6% and is as high as 6% in patients with IVI. Thus, both attending and residents experience relative increases in PCR rate with IVI. This study provides concrete evidence of the 2.56 times increased PCR risk in CEIOL with IVI history in resident cases and adds to the discussion of increased CEIOL complications in older patients. Therefore, along with intraoperative floppy iris syndrome, previous IVI may signal for the CEIOL to be performed by senior level residents and prompt added assistance and equipment in case of complications.
Dodaballapur S, Govindaraju V, Chao J, Desai M, Gupta C. Rates of posterior capsular rupture in ophthalmology resident cases after intravitreal injections. Invest Ophthalmol Vis Sci 2022 June;63(7):1701 – F0019.