抗VEGF内服注射を受けた眼の白内障手術中の後嚢破裂

Posterior capsule rupture during cataract surgery in eyes receiving intravitreal anti-VEGF injections.

• D Claire Miller
• Karen L Christopher
• Jennifer L Patnaik
• Anne M Lynch
• Leonard K Seibold
• Naresh Mandava
• Michael J Taravella

抄録

目的 手術前に抗血管内皮増殖因子（抗VEGF）の体外注射を受けた患者における、乳化白内障手術中の後嚢破裂（PCR）のリスクを検討する。方法 Sue Anschutz-Rogers UCHealth Eye Centerで2014年1月1日から2018年12月31日までに行われた白内障手術を対象にレトロスペクティブ研究を行った。主要転帰は手術中のPCRの発生であった。関心のあるその他の変数は、年齢、人種、性別、眼合併症、糖尿病、成熟白内障、主治医、注射頻度と種類、直近の注射日であった。PCRの予測因子は、患者の眼間の相関関係を考慮して、一般化推定式を用いたロジスティック回帰を用いて評価した。さらに、術中の特徴、術後合併症、および視覚的転帰を比較するために、抗VEGF注射歴がある場合とない場合のPCRを有する眼を対象に、追加のサブ解析を実施した。結果 合計 10,327 例の白内障手術が解析対象となり、そのうち 308 例が手術前に抗 VEGF 注射を受けていた。抗VEGF注射を受けた308例のうち、手術中にPCRを受けたのは8例（2.6％）であったのに対し、注射を受けなかった10,019例中45例（0.5％）であった（未調整OR=5.9、95％CI：2.8-12.7、p<0.0001）。男性と糖尿病患者は注射を受けた可能性が高く、PCRの発生率が高かったため、注射とPCRの関連についての多変量解析では、これらの変数が調整された（調整済みOR = 4.7、95％CI：2.1～10.4、p値=0.0001）。成熟した白内障を有する眼および研修医を執刀医として手術を受けた眼も PCR のリスクが高かったが、これらの変数は抗 VEGF 注射とは関連していなかった。注入頻度、直近の注入から手術までの時間、抗VEGF剤の種類はPCRと有意な関連はなかった。結論 抗VEGF注射歴は、白内障手術中のPCRの高いオッズと関連していた。

Purpose To examine the risk of posterior capsule rupture (PCR) during phacoemulsification cataract surgery in patients who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections prior to surgery. Methods A retrospective study was conducted of cataract surgeries at the Sue Anschutz-Rogers UCHealth Eye Center from 1/1/2014 through 12/31/2018. The primary outcome was occurrence of PCR during surgery. Other variables of interest included age, race, sex, ocular comorbidities, diabetes, mature cataract, primary surgeon, injection frequency and type, and date of most recent injection. Predictors of PCR were assessed using logistic regression with generalized estimating equations to account for correlation between patient eyes. Additional sub analysis was performed on eyes with PCR with and without anti-VEGF injection history to compare intraoperative characteristics, post-operative complications, and visual outcomes. Results In total 10,327 cataract surgeries were included in the analysis, and 308 of these eyes received anti-VEGF injections prior to surgery. Of the 308 eyes that received anti-VEGF injections, eight (2.6%) had a PCR during surgery compared to 45 of 10,019 eyes (0.5%) that did not receive injections (unadjusted OR = 5.9, 95% CI: 2.8 -12.7, p<0.0001). Males and diabetics were more likely to have received injections and had higher rates of PCR, so these variables were adjusted for in the multivariate analysis of the association between injections and PCR (adjusted OR = 4.7, 95% CI: 2.1 - 10.4, p-value=0.0001). Eyes with mature cataracts and those that underwent surgery with a resident as the primary surgeon were also at higher risk of PCR, but these variables were not associated with anti-VEGF injection. Injection frequency, time between most recent injection and surgery, and type of anti-VEGF agent were not significantly associated with PCR. Conclusions History of intravitreal anti-VEGF injections was associated with higher odds of PCR during cataract surgery.