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. 2024 Sep 26;16(9):e70297.
doi: 10.7759/cureus.70297. eCollection 2024 Sep.

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections

Duaa T Daradkeh  1 , Fedaa A Smadi  1 , Hala K Haddad  1 , Alaa A Smadi  2 , Sura Y Habashneh  1 , Zaineh A Shawareb  1
Affiliations

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections

Duaa T Daradkeh et al. Cureus. .

Abstract

Objectives: To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients.

Methods: A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05.

Results: The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%).

Conclusion: Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

Keywords: bevacizumab; diabetes mellitus; intravitreal; phacoemulsification; posterior capsular rupture.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the Royal Medical Services issued approval 35/122024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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