Surgical Complications and Visual Outcomes Following Cataract Surgery in Patients with Age-Related Macular Degeneration in the VA System

Abstract

Purpose: To compare the complication rates and visual outcomes of cataract surgery in veterans with age-related macular degeneration versus those without age-related macular degeneration (AMD).

Methods: This multicenter retrospective cohort analysis from the Ophthalmic Surgical Outcomes Data Project (OSOD) included 4891 of 4,923 cataract surgery cases from five VAMC sites. Data were collected according to OSOD definitions. Variables included in the analysis were ASA classification, age, gender, BMI, diabetes mellitus, hypertension, and glaucoma. Outcome variables were: BCVA, occurrence of minor complication, major complications and intraoperative events. Fisher’s exact, chi square, and McNemar’s tests were used for statistical analysis. A longitudinal data analysis using multivariate logistic regression for the main outcome, and multivariable logistic regression models for secondary outcomes were performed adjusting for potential confounders.

Results: Of 4891 eyes included, 394 (8.1%) had AMD. We compared this subset to those without AMD (91.9%, n=4497). Mean age was significantly higher in patients with AMD (77.5 ± 8.8 versus 69.96 ± 9.5, p<0.0001). There were no significant differences in gender, history of hypertension or glaucoma distributions between groups. Of all patients (AMD and non-AMD), 90.7% with BCVA worse than 20/40 improved to 20/40 or better post-surgery (p<0.0001). The percentage of eyes that improved was higher in those without AMD (92.9%) compared to that seen in those with AMD (68.8%), but the differences between pre- and post-operative visions were significant in both of these groups (p<0.0001). After adjusting for potential confounders, eyes with AMD had a significantly higher odds of having postoperative BCVA worse than 20/40. Nonetheless, there were no differences in the occurrence of intraoperative events, major or minor complications.

Conclusions: We found that cataract surgery is associated with a significant improvement in vision in patients with or without age-related macular degeneration. Though the presence of AMD is associated with a lower percentage of eyes improved, the change in pre- vs. -post BCVA is still significantly significant in the AMD group, suggesting cataract surgery is also of benefit for these patients. We found no significant difference in complication occurrence or intraoperative events between groups.

Keywords: 445 cataract • 412 age-related macular degeneration • 462 clinical (human) or epidemiologic studies: outcomes/complications