In this retrospective, matched case-controlled study, researchers assessed outcomes after cataract surgery in patients who underwent treatment for neovascular AMD (nAMD).
Study design
Investigators identified 124 nAMD patients who were scheduled for cataract surgery and 372 control unoperated phakic eyes. The controls were matched for nAMD treatment before surgery, baseline visual acuity, age, and length of follow-up.
Outcomes
Twelve months after surgery, visual acuity was higher in eyes that had cataract extraction compared with controls (65.8 vs. 61.3 letters; P=0.018). The mean visual acuity gained was 10.6 letters (P<0.001), with 26% gaining 3 or more lines and 1.6% losing 3 or more lines.
Neither the number of active choroidal neovascular (CNV) lesions nor the mean number of injections significantly changed before and after surgery. Both parameters, however, decreased in the control cohort, which suggests that surgery increased the level of CNV activity.
Vision loss was more common in patients who underwent surgery within the first 6 months of anti-VEGF therapy (P=0.023). Visual acuity outcomes did not correlate with age, lesion type or an injection 2 weeks prior to surgery.
Limitations
Although this study is limited by its retrospective design, observational data may be the best way to study the safety and efficacy of cataract surgery in this clinical context since randomized clinical trials may pose ethical complications. Some relevant information was unavailable, such as rationale for surgery, cataract type and grade, and surgical details. Bias may have been introduced by the surgical decisions made at the treating physician’s discretion. In some cases, postoperative cystoid macular edema may have been challenging to differentiate from CNV recurrence/activity.
Clinical significance
Overall, this study found cataract surgery benefited eyes undergoing treatment for nAMD despite some evidence of a modest effect on CNV lesion activity. However, cataract surgery within 6 months of initiation of anti-VEGF therapy for neovascular AMD should be avoided, if possible.