Key takeaways:

• Postoperative macular edema was less frequent in eyes recently treated with anti-VEGF vs. not recently treated.
• Anti-VEGF within 35 days before cataract surgery may benefit patients with retinal vein occlusion.

Anti-VEGF injections before cataract surgery may protect eyes with retinal vein occlusion from developing postoperative macular edema, according to data published in BMC Ophthalmology.

“Patients with [retinal vein occlusion] and concurrent cataract have been shown to benefit from cataract extraction to significantly improve visual outcomes,” Kevin Dahlan, MD, of the department of ophthalmology at Stony Brook University Hospital, and colleagues wrote. “However, [cataract extraction] poses challenges, as it significantly increases the risk of postoperative macular edema in patients with preexisting [retinal vein occlusion].”

Anti-VEGF injections before cataract surgery may protect eyes with retinal vein occlusion from developing postoperative macular edema. Image: Adobe Stock

To see whether recent anti-VEGF treatment had any influence on this risk, Dahlan and colleagues retrospectively reviewed data on 53 eyes from 51 patients who had retinal vein occlusion, either central (43.4%) or branch (56.6%), followed by cataract surgery in the same eye.

Of the 53 eyes, 38 had received anti-VEGF therapy prior to cataract surgery and 15 were treatment naïve. The researchers compared postoperative macular edema rates according to whether the most recent anti-VEGF injection occurred within 35 days of surgery or more than 35 days before surgery.

Among the previously treated eyes, postoperative macular edema was significantly less frequent in eyes that had anti-VEGF therapy within 35 days of surgery (12.5%) vs. those treated more than 35 days before surgery (57.1%).

The finding could indicate that anti-VEGF therapy “ameliorates the vascular permeability” underlying macular edema after cataract extraction in patients with retinal vein occlusion, the researchers wrote.

Rates of postoperative macular edema were similar between eyes treated with anti-VEGF at any time in the past (28.9%) and those never previously treated with anti-VEGF (20%). This “suggests that any long-term prior anti-VEGF exposure does not grant durable protection against postoperative macular edema,” the researchers wrote.

In the subset of eyes with ischemic retinal vein occlusion, no postoperative macular edema occurred among those recently treated with anti-VEGF, compared with 80% of those treated more than 35 days before surgery.

In a multivariate analysis adjusted for ischemic status and diabetes, recent anti-VEGF treatment was still the only significant factor in the odds of postoperative macular edema.

Overall, 26.1% of eyes developed postoperative macular edema at an average of 48.1 days after surgery. The researchers noted a “high incidence” of postoperative macular edema in eyes with retinal vein occlusion, “regardless of disease activity level.”

“This high incidence suggests that pretreatment may be beneficial for all patients, regardless of prior disease activity, to prevent [postoperative macular edema],” the researchers wrote.