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Jordan Reed, Nicholas Chung, George Benjamin Berrett, Mark Pearce, Jeffry Hogg, Sandro Di Simplicio; An observational clinical study of the influence of phacoemulsification on choroidal neovascular membrane activity in age related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2021;62(8):635.
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© ARVO (1962-2015); The Authors (2016-present)
Thousands of phacoemulsification surgeries are performed on eyes with exudative age-related macular degeneration (exAMD) in the United Kingdom each year. Controversy over phacoemulsification’s influence on exAMD disease activity limits the information which can inform clinicians’ and patients’ management decisions. This observational study aims to resolve this by reporting on intravitreal injection (IVI) frequency as a pragmatic marker of exAMD disease activity in a large cohort.
A cohort of eyes with exAMD (n=327) that underwent phacoemulsification at a single tertiary centre from 2014-2019 were identified. Cases were matched by length of exAMD diagnosis at a specified ‘time-zero’ within the follow-up of pseudophakic eyes with exAMD (n=327). Data concerning demographics, visual acuity (VA) and intravitreal injection frequency (IVI) before and after ‘time-zero’/phacoemulsification were collected. The primary outcome was change in IVI frequency following ‘time-zero’/phacoemulsification which was analysed through a 2-tailed Mann Whitney U-test and univariate and multivariable linear regression.
Following ‘time-zero’/phacoemulsification’ mean reduction in annual IVI frequency was 0.6 injections/year (95%CI 0.4,0.9) and 0.4 injections/year (95%CI 0.1,0.7) in the comparison and phacoemuslification cohorts respectively. Mean VA gain 12 months after phacoemulsification was 11.3 (95%CI 9.2,13.4) early treatment of diabetic retinopathy study (ETDRS) letters, with 214 eyes (65.4%) gaining ≥5 ETDRS letters after surgery. On multivariable linear regression, phacoemulsification during follow-up was found to significantly (p=0.015) independently increase annual IVI frequency by 0.39 (95% CI 0.07,0.71) injections, with minimal overall direct and indirect effects (R2=0.01). Multivariable linear regression with final VA as the dependent variable found no significant influence from baseline demographics or length of exAMD diagnosis.
Whilst phacoemulsification appears to have a statistically significant independent exacerbating effect on exAMD disease activity, this effect is too small to be considered clinically significant. Phacoemulsification should be offered to patients regardless of exAMD diagnosis and independently of their gender, age and length of exAMD diagnosis.
This is a 2021 ARVO Annual Meeting abstract.
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