NOV 13, 2009
Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous
The authors prospectively enrolled into their study 86 patients (86 eyes) with dry AMD scheduled for cataract surgery. They carefully documented stereoscopic color fundus photographs and fluorescein angiograms immediately before and after surgery to document AMD progression in the first 12 months after cataract surgery.
Five eyes appeared to have disease progression one week after surgery, suggesting that the lesions were present before surgery; the lens opacity had just obscured detection. After excluding these five eyes and one eye with poor imaging, only three of 65 eyes, or 4.6 percent, that were free of wet AMD at the preop visit and at one week postop developed wet AMD by 12 months.
This rate was not significantly different from the rate in patients' unoperated eyes; only one (3.3 percent) developed new AMD lesions during the same period.
The authors write that the "low incidence rate of neovascular AMD development between 1 week and 1 year after cataract surgery did not support the hypothesis that cataract surgery increases the risk of AMD progression." The five eyes that developed wet AMD one week after surgery do however suggest that many cases of presumed progression to wet AMD following cataract surgery "may have been present prior to cataract surgery, but not recognized owing to lens opacity."
Dr. Barbara E. K. Klein from the University of Wisconsin writes a companion editorial in which she reviews several studies - mostly observational studies - since the late 1980s that have indicated an association between cataract surgery and AMD progression and points to the need for a better intrapatient study that could possibly take place in the future. Her conclusion is:
"However, while awaiting such a study, what should the practitioner do regarding cataract surgery when faced with a patient who has cataract causing visual loss and affecting function in one eye with early AMD and with advanced AMD in the fellow eye? A straightforward discussion of the inconsistencies of the research findings to date regarding risks of progression of early AMD and development of late AMD and its accompanying risk of severe loss of acuity after cataract surgery will help both the patient and his or her physician to make a more informed decision. Until we have better information regarding the risk of developing AMD in those undergoing cataract surgery, it is the best we can do for our patients."