Effect of cataract surgery on wet age-related macular degeneration activity.

Petteri Karesvuo,Kai Kaarniranta,Uri Elbaz,Raimo Tuuminen,Idan Hecht,Asaf Achiron

doi:10.1111/aos.14864

Abstract

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. 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. Mean age was 78.9 ± 5.6 years at the time of surgery. Central subfield macular thickness (CSMT) significantly decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, p = 0.001, and to 265.9 ± 67.9 µm at 1 year, p = 0.003), visual acuity improved (0.70 ± 0.46 logMAR units preoperatively to 0.39 ± 0.40 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, p < 0.001 for both) and anti-VEGF treatment intervals lengthened despite the surgery (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, p = 0.246, and to 7.05 ± 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). 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.

Highlights

Age-related macular degeneration (AMD) is the leading cause of visual impairment in western countries with increasing global incidence (Wong et al 2014; Mitchell et al 2018)
In this retrospective registry-based study, we show that cataract surgery does not cause progression or worsening of wet age-related macular degeneration (AMD)
The mean treatment interval of anti-VEGF injections did not change after surgery compared to the preoperative period

Summary

Introduction

Age-related macular degeneration (AMD) is the leading cause of visual impairment in western countries with increasing global incidence (Wong et al 2014; Mitchell et al 2018). Antivascular endothelial growth factor (anti-VEGF) injections have revolutionized the prognosis of wet AMD. Cataract reduces retinal visibility and hinders treatment, in addition to reducing patients’ vision It is, not completely clear whether wet AMD should be treated with the normal antiVEGF protocol despite cataract surgery, and whether it is justified to postpone cataract surgery depending on disease activity. Wet age-related macular degeneration (AMD) and age-related cataract are often coexisting causes of visual impairment. 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. We found no evidence to support delaying surgery in patients who require it

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