Intravitreal injection history and cataract surgery complications: A multicenter retrospective cohort

• IVI within 90 days of cataract surgery increased postoperative macular edema risk. • Vitreous hemorrhage risk was greater at 90 days in patients with preoperative IVI. • No increased risk found for infection, retinal detachment, or other complications. To evaluate whether a recent history of intravitreal injection is associated with postoperative complications after cataract surgery in a large, real-world cohort. Retrospective, propensity score–matched cohort study. Adults undergoing cataract surgery with or without at least one intravitreal injection within 90 days before surgery were identified from the U.S. TriNetX research network. Cohorts were matched for demographic characteristics and ocular and systemic comorbidities. Postoperative complications at 14, 30, and 90 days were compared using risk ratios with 95% confidence intervals. After matching, 10,107 patients with recent intravitreal injection and 10,107 controls were included. A recent intravitreal injection history was associated with higher rates of postoperative macular edema at 14, 30, and 90 days (RR range 2.07–2.69) and vitreous hemorrhage at 90 days (RR 1.74). Absolute risk differences were modest. No significant associations were observed for infection, retinal detachment, anterior vitrectomy, lens dislocation, anterior uveitis, or secondary lens procedures. In this large retrospective analysis, patients undergoing cataract surgery with a recent history of intravitreal injection had higher observed rates of postoperative macular edema and vitreous hemorrhage, while other major complications were not increased. These associations likely reflect the presence of underlying retinal disease rather than a direct effect of the injection procedure itself and should be interpreted as non-causal.