COMMENTARY

Is Cataract Surgery Safe for Patients With Wet AMD?

Matthew R. Starr, MD; Sophie J. Bakri, MD

Disclosures

January 19, 2016

The Effects of Cataract Surgery on Patients With Wet Macular Degeneration

Saraf SS, Ryu CL, Ober MD
Am J Ophthalmol. 2015;160:487-492.e1

Study Summary

This retrospective cohort study examined patients with active wet age-related macular degeneration (AMD) who underwent cataract surgery. The study included two cohorts, a surgical group with 40 eyes and a nonsurgical group with 42 eyes. The primary focus was to assess the visual outcomes and possible complications of cataract surgery in patients with wet AMD. The study examined patients during a 1-year timeframe before and after undergoing cataract surgery, with outcomes assessed 3 months before and after a designated midway point in the year.

All patients received the treat-and-extend protocol for the management of AMD. This involved an induction with three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents, and extended based on monthly optical coherence tomography (OCT) findings.

Patients being treated with anti-VEGF agents for other conditions that could contribute to neovascularization, such as proliferative diabetic retinopathy or retinal vascular occlusion, were excluded. Other ocular conditions that could significantly affect visual acuity, such as advanced glaucoma or retinal detachment, also were excluded.

The study found no significant difference in best-corrected visual acuity (BCVA) between the two groups during the presurgery portion of the study. After cataract surgery, the surgical group had a significant improvement in BCVA compared with the nonsurgical group.

There was no change in the number of injections given after the midpoint of the year between the groups. However, the nonsurgical group showed a nonstatistically significant trend toward a decrease in the number of injections after the midway point. The authors postulated that this might be related to providers being more reluctant to extend the surgical group due to increased macular edema or simply due to the surgery itself.

The surgical group had a significant increase in central retinal thickness based on OCT. They also were more likely to develop new or worsening cystoid macular edema compared with the nonsurgical group.

Viewpoint

Previous studies had been unable to conclusively establish a relationship between cataract surgery and the progression of wet AMD after surgery. This study concludes that patients with stable disease may be candidates for cataract extraction. They probably will not have a worse outcome and, in fact, will have improved BCVA after surgery.

The authors expressed caution in adopting their findings for all wet AMD patients. Cataract extraction ought to be limited only to patients with stable disease—a safe strategy considering that outcomes after cataract surgery in patients with wet AMD are still debatable.

Limitations to this study include its small number of participants. Some trends might become significant with an increase in the number of participants.

Still, this study concludes that patients will have an improvement in BCVA after cataract surgery but at the cost of an increased number of intravitreal injections of anti-VEGF agents.

Abstract

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