Impacts of cataract surgery in eyes treated by anti-vascular endothelial growth factor therapy for wet age-related macular degeneration on visual outcomes

Abstract

Purpose : The effects of cataract surgery on eyes with early and advanced stages of age-related macular degeneration (AMD) are still controversial. The purpose of this study was to evaluate the impacts of cataract surgery on eyes treated with anti-vascular endothelial growth factor (VEGF) therapy for wet AMD.

Methods : Fifty-eight eyes of 58 patients (42 men and 16 women) with wet AMD treated by intravitreal ranibizumab or aflibercept, which underwent cataract surgery, were enrolled. Mean age was 77 years. Twenty-eight eyes underwent cataract surgery in the inactive phase of wet AMD, which was defined as no anti-VEGF therapies for 6 months prior to the cataract surgery, while 30 eyes underwent cataract surgery simultaneously with the anti-VEGF therapy in the active phase. Best-corrected visual acuities (BCVAs) measured 1 and 12 months after the cataract surgery and at the last visit were assessed in the logarithm of minimal angle of resolution unit. The number of intravitreal injections and macular volume (MV) measured by optical coherence tomography were compared before and after the cataract surgery.

Results : Of 28 eyes with the cataract surgery in the inactive phase, 16 eyes had no injections for 37 months of mean follow-up period. The mean BCVA of these eyes was 0.50 in month 1, similar to 0.53 in month 12, thereafter, slightly decreased to 0.61 at the last visit (p=0.026, paired t-test). On the other hand, the other 12 eyes required anti-VEGF therapy with mean injection number of 1.8 for the first year and 6.2 for 47 months of mean follow-up period. The mean BCVA decreased from 0.55 in month 1 to 0.61 in month 12 (p=0.122) and to 0.78 at the last visit (p=0.005). In 30 eyes with the cataract surgery in the active phase, the injection number increased from 3.1 for 1 year before the surgery to 3.7 for postoperative 1 year (p=0.047). The postoperative mean injection number was 8.5 for 42 months of mean follow-up period. The mean BCVA of 0.40 in month 1 was similar to 0.39 in month 12 (p=0.474) but deteriorated to 0.61 at the last visit (p=0.001). The mean range of MV immediately after the cataract surgery was 9.4 to 10.0 (mm2), significantly larger than before (9.2 to 9.4) (p=0.033 and p=0.001, respectively).

Conclusions : The cataract surgery may affect wet AMD with anti-VEGF therapy, requiring careful monitoring and more frequent injections.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.