OBJECTIVE: To compare cataract surgery complications in patients with and without prior intravitreal injection (IVI). DESIGN: A retrospective cohort study using the TriNetX aggregated research network. SUBJECTS: Patients with IVI therapy within twenty years of cataract surgery were compared to controls using propensity score matching (PSM) to balance for demographics, systemic, and ocular co-morbidities. Patients with lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded. INTERVENTION: IVI within twenty years of cataract surgery. MAIN OUTCOME MEASURES: Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery. RESULTS: Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34
95% CI:1.16-1.54) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84
95% CI:1.27-2.66) and 90 days (RR 2.05
95% CI:1.65-2.54). IVI was only associated with higher rates of anterior vitrectomy in patients with diabetic retinopathy (DR) at 90 days (RR 1.24
95% CI:0.85-1.79). Patients with DR and IVI exposure had more lensectomies, RD repairs, and secondary procedures. CONCLUSIONS: Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.