Effect of cataract surgery on wet age‐related macular degeneration activity

Abstract

Background: Wet age-related macular degeneration (AMD) and age-related cataract are often coexisting causes of visual impairment. Yet, the timing of cataract surgery in wet AMD patients is controversial. Methods: One hundred and eleven eyes of 111 patients with wet AMD underwent cataract surgery at Helsinki University Hospital in Finland during 2014-2018. Best-corrected visual acuity and central subfield macular thickness (CSMT) were analysed at the time of wet AMD diagnosis, at the last recording prior to cataract surgery and at the first recording and at 1 year after surgery. The cumulative number of antivascular endothelial growth factor (anti-VEGF) injections at surgery, systemic and topical medication and postoperative anti-VEGF burden were recorded. Results: Mean age was 78.9 AE 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 AE 75.0 µm preoperatively to 268.6 AE 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 AE 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 AE 0.46 logMAR units preoperatively to 0.39 AE 0.40 at the first postoperative recording, and to 0.33 AE 0.34 at 1 year, p < 0.001 for both) and anti-VEGF treatment intervals lengthened despite the surgery (6.53 AE 2.08 weeks prior to surgery to 7.03 AE 2.23 weeks at 1 year, p = 0.246, and to 7.05 AE 2.57 weeks at the last documented visit, p = 0.035). A CSMT increase of over 30% from the preoperative values was seen in only one case (1 out of 111 eyes, 0.9%). Macular status at surgery, wet AMD subtype, comorbidity of type II diabetes, systemic drugs and topical anti-inflammatory medication were not associated with macular changes nor with treatment intervals after surgery. The cumulative number of anti-VEGF injections correlated neither with CSMT change postoperatively (r = −0.051, p = 0.619) nor with CSMT change at 1 year (r = 0.091, p = 0.426). Conclusion: Satisfactory visual outcomes and controlled disease activity were seen in patients with wet AMD undergoing cataract surgery. We found no evidence to support delaying surgery in patients who require it.

The intraocular implant and visual rehabilitation improve the quality of life of elderly patients with geographic atrophy secondary to age-related macular degeneration

“…Even more demanding cataract surgery does not increase the risk of pre-existing GA progression [35]. Equally, satisfactory visual outcomes and controlled disease activity were found in patients with wet AMD after cataract surgery [36]. There was no case of rapid worsening of GA, no change to neovascular AMD, and no need for anti-VEGF application after SML implantation in our study.…”

The Effect of Intravitreal Bevacizumab Injection in Wet Age-Related Macular Degeneration Patients with Cataract Surgery

“…AREDS (age-related eye disease study)는 나이관련황반변성을 진단받은 1,939안을 대상으로 시행한 코호트 연구로 백내장 수술을 시행하 고 최소 18개월까지 경과를 보았고 그 기간 내에 유의한 시력호전 을 보였다고 하였다[33]. 그 외에도 백내장수술이 나이관련황반변 성의 질병 활성도에 영향을 미치지 않으며 시력 호전을 보인다는 연구는 다수 있었다[34][35][36]. 그러므로 백내장 수술과 동시에 유리 체강내 베바시주맙 주입술을 시행하는 경우 발생할 수 있는 백내장 수술 후 발생할 수 있는 황반부종을 억제할 수 있을 것으로 생각되 었다.…”