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J. J. Wang, E. Rochtchina, S. Cugati, T. de Loryn, C. Fong, J. Arnold, W. Smith, P. Mitchell, Cataract Surgery and AMD Study; Progression of Age-Related Macular Degeneration in Eyes After Cataract Surgery: 12 Months Follow-Up of a Large Surgical Cohort. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1663.
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To assess the risk of age-related macular degeneration (AMD) progression after cataract surgery in a large patient cohort.
The Cataract Surgery and AMD Study followed 1994 patients aged 65+ years who had cataract surgery at a public hospital in western Sydney. Patients were examined and had retinal photography before or within 4 weeks of surgery (baseline) and 6- and 12-months after surgery. AMD progression was assessed using side-by-side grading of retinal images from each visit. Early AMD was defined to include large indistinct soft or reticular drusen, or co-existing large distinct soft drusen and retinal pigment epithelial (RPE) changes. Risks of developing AMD in operated compared to non-operated eyes were assessed in patients remaining phakic in one eye for at least 12 months (unilateral surgery), using generalized estimating equation (GEE) models, adjusting for known AMD risk factors.
We followed 1562 patients for 12 months after surgery. Of 1505 patients with complete baseline data, mean age was 75 years, hypertension was present in 61%, diabetes in 29%, late AMD in 2.5% and early AMD lesions in 53.1%. One year after surgery, the person-specific late and early AMD incidence was 1.0% and 10.5%, respectively. Of those who had only unilateral surgery for 12 months and who were at risk of late AMD (n=478), this developed in 4 (0.84%) operated and 5 (1.05%) non-operated fellow eyes of the same patients (p=0.7, age-adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.25-2.57). Of the corresponding unilateral surgery group at risk of early AMD (n=345), this developed in 26 (7.54%) operated and 21 (6.09%) non-operated fellow eyes (p=0.4). In a model adjusting for age and presence of baseline RPE changes and distinct soft drusen, cataract surgery was not a significant predictor of incident early AMD (OR 1.02, 95% CI 0.57-1.84). However, increasing age (OR 1.07, 95% CI 1.01-1.14 per year) and presence of RPE changes (OR 4.81, 95% CI 1.91-12.1) or distinct soft drusen (OR 4.61, 95% CI 2.33-9.09) were predictors.
In a large surgical cohort, documented pre-existing early AMD lesions and older age, but not cataract surgery, were associated with greater AMD progression in the first 12 months after surgery.
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