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Steven Saraf, Christina Ryu, Michael D Ober; Outcomes in wet age-related macular degeneration after cataract extraction. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5372.
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To explore whether cataract surgery contributes to the progression of wet age-related macular degeneration (wet AMD).
Two cohorts of eyes with active wet AMD were included. The first included eyes with the diagnosis of wet AMD that underwent cataract surgery at the midpoint of a one year study window. The second included control eyes with wet AMD that did not undergo cataract surgery in the year 2012. The midpoint in the non-surgical group was defined as 7/1/2012. The best corrected visual acuity (BCVA) and number of anti-VEGF injections were compared between the two groups. OCT data was compared including central thickness, presence of cysts, and presence of subretinal fluid.
The study included 40 eyes in the surgical group and 42 in the non-surgical group. BCVA was equivalent in the first half of the study. The mean change in BCVA was statistically significant between the two groups after the midpoint with surgical eyes improving 0.23 ± 0.65 LogMAR and non-surgical eyes improving 0.11 ± 0.59 LogMAR (p=0.049). There was no significant difference in the number of injections given 6 months before and after the midpoint in the surgical group (2.31 ± 1.40 injections before versus 2.30 ± 1.45 after, p=0.921). Non-surgical eyes received 3.00 ± 1.45 injections before and 2.57± 1.45 after and this difference approached significance (p= 0.057). Analysis of OCT data showed a significant difference in final central thickness with surgical eyes measuring 265.4 ± 98.4 microns and non-surgical eyes measuring 216.4 ± 58.3 microns (p=0.011). A significant difference was found in the presence of new or worse cysts after the midpoint with worsening in 13 surgical eyes (54.2%) and 9 non-surgical eyes (28.1%, p=0.048).
Cataract surgery did not appear to contribute to significant worsening of wet AMD when comparing the number of anti-VEGF injections and led to improvement in BCVA. However, subclinical worsening was suggested when looking at certain OCT features.
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