The Effects of Cataract Surgery on Patients With Wet Macular Degeneration

Saraf, Steven S.; Ryu, Christina L.; Ober, Michael D.

doi:10.1016/j.ajo.2015.06.006

Cited by 33 publications

(31 citation statements)

References 27 publications

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“…Apart from epidemiological cross-sectional studies, meta-analyses, and cohort studies, several smaller studies, similar to our randomized study in both the number of patients and study duration, have investigated the relationship between cataract surgery and AMD. Saraf et al performed a retrospective study of the effects of cataract surgery on BCVA, CRT, and the number of anti-VEGF injections in 2 groups of patients with wet AMD [ 39 ]. In total, 40 eyes underwent cataract surgery and the other 42 eyes did not.…”

Section: Discussionmentioning

confidence: 99%

Effect of Phacoemulsification on Visual Acuity and Macular Morphology in Patients with Wet Age-Related Macular Degeneration

2018

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BackgroundThis article discusses the effectiveness of phacoemulsification cataract surgery with intraocular lens implantation in patients with wet age-related macular degeneration in the inactive phase of the disease.Material/MethodsForty-nine patients (50 eyes) aged 78.94±5.54 years, previously treated with intravitreal injections of anti-vascular endothelial growth factor agents, were qualified for a prospective, randomized 12-month study. The participants were divided into 2 groups. Group I consisted of 25 patients (25 eyes) who were subjected to phacoemulsification cataract surgery. Group II consisted of 24 patients (25 eyes) who were not subjected to phacoemulsification cataract surgery despite having a lens opacity of grade II or higher according to the Lens Opacities Classification System.ResultsAfter 12 months of follow-up, patients in group I gained on average 8.04 letters (p<0.001). Furthermore, 20% of the eyes had a significant improvement in best corrected visual acuity of ≥15 Early Treatment of Diabetic Retinopathy Study Chart letters. Patients in group II lost on average 1.96 letters (p>0.05). No significant differences between central retinal thickness values in either group (p>0.05) were noted. The mean number of intravitreal injections of anti-vascular endothelial growth factor agents during the study was 2.64±1.98 in group I and 2.92±2.40 in group II (p>0.05).ConclusionsPhacoemulsification performed in eyes with wet age-related macular degeneration during the inactive phase of the disease significantly improves visual acuity. In addition, it does not significantly influence the frequency of intravitreal injections of anti-vascular endothelial growth factor agents or disease activity.

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Section: Discussionmentioning

confidence: 99%

Effect of Phacoemulsification on Visual Acuity and Macular Morphology in Patients with Wet Age-Related Macular Degeneration

2018

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“…They found that shorter delays of cataract surgery after diagnosis of wet AMD and shorter exudation-free periods before cataract surgery were associated with increased risk of recurrence. Thus, they suggested lower risk of recurrence for eyes with stabilized exudation more than 12 months; but, unfortunately this study did not compare with a control group (non-surgical group) [38].…”

Section: Neovascular Amdmentioning

confidence: 91%

“…It is known that neovascular AMD, can compromise in 90% of cases severely the vision (20/200 or worse) if left untreated [37], but with the advent of anti-vascular Endothelial Growth Factor (anti-VEGF) intravitreal injections as therapy in wet AMD has got stabilize (90%) or even improved vision (30%) in a large number of cases [38][39][40][41][42][43].…”

Section: Neovascular Amdmentioning

confidence: 99%

“…In addition, the protocols used in the reported studies, were inhomogeneous (treat and extend, pro-re-nata and monthly injections), but none compared these protocols between them, or even between different anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) [38,39,[41][42][43][52][53][54][55]. Then, it is required prospective research of causality and not only epidemiological studies, with long periods of follow-up to clarify studies published until now concerning this issue.…”

Section: Neovascular Amdmentioning

confidence: 99%

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2016

OCR

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Age-related cataracts are a worldwide cause of blindness in 10.8 million of people and 35.1 million were visually impaired in 2010, it means that cataract caused 33.4% of blindness and 18.5% of moderate to severe vision impairment [1]. Cataract prevalence increase as people age, by age 75, half of population have a cataract; by age 80, 70% of whites, 53% of Africans and 61% of Hispanics [1,2]. Cataract surgery is a successful procedure in the majority of cases (about 95%) [2]. Although, it is not free of complications, because of the surgical procedure itself or due to coexisting ocular pathology; for example, the global incidence of post surgical cystoid macular edema is about 1.17%, but it is 4-fold increase in eyes with diabetic retinopathy, 5.6-fold in epiretinal membrane and 30-fold in retinal Age related-Macular Degeneration (AMD) is an acquired condition of the retina that causes significant central visual impairment and legal blindness in elderly people [4,5]. In the United States, the prevalence of AMD for people older than 40 years is estimated at 9.2%, then it increases exponentially, reaching 22.8% after 75 years old [6,7]. Recently (2016) an incidence study selected by ethnicity in a population based in the United States was published, finding an overall incidence of 4.1% in Early AMD and 2.3% in late AMD, the white population is the most affected population by 5.3% and 4.1% respectively [3].Thus, cataract and AMD are both age-related conditions that share similar comorbidities (hereditary, cardiovascular risk, free radicals, tobacco, sun exposition, etc.) [5,[8][9][10][11][12]. It is difficult to demonstrate a correlation between cataract surgery and AMD progression or deterioration because of this close relationship. Also, cataract development itself could preclude visualization of posterior pole and prevent a correct diagnosis of AMD [13][14][15][16]. Despite this, concern still exists in ophthalmologists about the behavior of the AMD or the choroidal neovascularization in a patient undergoing cataract surgery.The possible relationship of AMD and cataract surgery was reviewed and discussed. A very extensive searching was made; we analyzed randomized and non-randomized control trials, prospective and clinical trials. We discuss separately each type of AMD following AREDS classification. Likewise, we have intended to extract some recommendations to follow in this complicated scenario according recently clinical evidence. Early-Intermediate AMD and Cataract SurgeryThere are at least four main studies concerning cataract surgery and AMD development, the Beaver Dam Study (BDS), Blue Mountains eye Study (BMS), Rotterdam Eye Study, Los Angeles Latino Eye Study (LALOS). They evaluated the incidence of early manifestations of AMD in patients without signs of AMD at baseline who were submitted to cataract surgery and they did not find a relationship with early AMD.However, there are numerous publications found a possible relationship and they have suggested mechanisms that could lead to progression in AMD ...

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“…The studies published about cataract surgery in patients with neovascular AMD are mainly retrospective, FAG was only performed as a diagnostic test and not on the follow-up; some of them without control group and with short periods of follow-up [15,16,[25][26][27][39][40][41][42][43][50][51][52][53][54][55]58]. In addition, the protocols used in the reported studies, were inhomogeneous (treat and extend, pro-re-nata and monthly injections), but none compared these protocols between them, or even between different anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) [38,39,[41][42][43][52][53][54][55]. Then, it is required prospective research of causality and not only epidemiological studies, with long periods of follow-up to clarify studies published until now concerning this issue.…”

Section: Neovascular Amdmentioning

confidence: 99%