Cataract surgery appears to have good outcomes in wet AMD patients

 This retrospective case series in the April issue of the Journal of Cataract & Refractive Surgery examined outcomes in patients with visually significant cataract and wet age-related macular degeneration (AMD) who underwent cataract surgery. The results indicate that with regular evaluations and appropriate treatment with anti-vascular endothelial growth factor (anti-VEGF) agents, cataract surgery did not appear to be associated with an increased incidence of perioperative complications or macular adverse events in patients being treated for both cataract and wet AMD.

The authors reviewed the charts of 28 patients (30 eyes) with wet AMD treated by anti-VEGF therapy who had cataract surgery. Mean follow-up was 14.3 months.At the time of surgery, the choroidal neovascular complex was considered stable, with 22 eyes in a drug-free phase.

Forty-seven percent of eyes improved by two or more lines. Corrected distance visual acuity (CDVA) was 20/40 or better in 10 percent of eyes preoperatively and 40 percent postoperatively. The change in CDVA from preoperatively to postoperatively was statistically significant, with a mean change of 0.22 logMAR ± 0.27 (SD) at two months (P < 0.0001), 0.22 ± 0.36 logMAR at six months (P = 0.001) and 0.17 ± 0.54 logMAR at the last follow-up (P = 0.01). There were no perioperative macular adverse events.

In the 28 eyes without submacular hemorrhage, mean improvement in CDVA was 0.26 logMAR at the last follow-up. The majority of patients who did not have a significant increase in CDVA reported a qualitative improvement in vision, including in brightness and color perception.

Patients received a mean of 0.32 injections per month postoperatively compared with 0.49 injections per month preoperatively. The authors say the reduced number of injections after surgery likely reflects the fact that many patients were in the remission phase at the time of surgery.

Although the risks of cataract surgery do not appear to be significantly elevated in patients with stable wet AMD, the authors say it is prudent to have a higher threshold for surgery in these patients than in those without wet AMD. They recommend treatment with intravitreal anti-VEGF therapy one to two weeks before cataract surgery to further stabilize the choroidal neovascular complex and minimize the potential risk for hemorrhage and postoperative edema. They say that in cases with apparently stable wet AMD, pretreatment with anti-VEGF agents stabilizes undetected subclinical choroidal neovascular activity, although individual cases that have been stable for a long period before cataract surgery may not require pretreatment with anti-VEGF agents.