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S. Brunner, I. Krebs, U. Stolba, C.I. Falkner, S. Binder, P. Bauer; Cataract Surgery in Nonexsudative Age–Related Macular –First Results of a Prospective, Randomized, Multicenter Trial (ECAM–1) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):195.
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Purpose: Age–related macular degeneration (AMD) and senile cataract are the most common causes for visual impairment in people over 60. As a growing coincidence of both diseases is found, there is much uncertainty about the usefulness of cataract surgery in coexistent non–exsudative AMD. Epidemiologic data from large cross–sectional studies were promising an increased risk of progression to late AMD for pseudophakic eyes after 10 years. However, screening for large trials is done without angiographic grading support in most cases. Methods: ECAM–1 is a randomized, prospective study, scheduled for four years in several centers. Our challenge is to find out if cataract surgery might influence morphology and course of coexisting non–exsudative AMD. Patients are constantly randomized into an early–surgery group and a control group; non–exsudative AMD (drusen or pigment epithelial atrophy) is always confirmed by fluorescein angiography before inclusion. After a follow–up of 6 months in both groups, acuity results, questionnaires of visual function and digitized images are analysed, with AMD size and acuity tests as the main criteria. Results: Until december 2004, 44 eyes of 44 patients had been included, of which 30 had completed all study procedures. As preliminary data, the average age was 79 years. In the early–surgery group (n=17), an average increase in distance acuity from Snellen 0,26 to 0,33 was found after 6 months, whereas in the control group (n=13), acuity increase was smaller from Snellen 0,22 to 0,27. Concerning subjective visual function, VF–14–questionnaires showed an average increase from 2,72 to 2,92 points and from 2,43 to 3,04 points, respectively. We could not observe a change in AMD size or progression to exsudative AMD in any case, although asymptomatic central leakages in 4 out of 44 eyes had been identified only by fluorescein angiograms. Conclusions: Cataract extraction in AMD is always regarded with great caution, especially in cases representing the borderline from non–exsudative to exsudative AMD, being targeted by most of the modern therapeutic approaches. So far, what is regarded as dry AMD clinically can even turn out as exsudative disease in fluorescein imaging. Our first data indicate that cataract surgery may be safe for patients with confirmed dry AMD, resulting in improved visual function without AMD progression in the first six months.
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