Does Cataract Surgery Improve Vision in Patients With Neovascular AMD?
American Journal of Ophthalmology, June 2018
The question of whether cataract surgery improves vision in patients with certain types of age-related macular degeneration (AMD) continues to be the subject of some debate. Daien et al. looked at visual acuity (VA) data for patients with neovascular AMD who did and did not receive cataract surgery. They found that, although cataract surgery appeared to modestly increase the activity of choroidal neovascular (CNV) lesions, visual outcomes were good.
For this retrospective case-control study, the researchers gathered information from the Fight Retinal Blindness! observational database. Records for eyes that underwent cataract surgery and were monitored since the start of neovascular AMD treatment (n = 124) were compared with records for unoperated phakic eyes that also were being treated for neovascular AMD (control group; n = 372). Cases were matched for age, baseline VA, and duration of treatment and follow-up.
By 12 months postoperatively, cataract surgery resulted in a mean gain of 10.6 letters, and the mean VA was better for operated eyes (65.8 vs. 61.3 letters; p = .018). The mean number of anti-VEGF intravitreal injections and the proportion of visits in which CNV lesions were active did not change substantially after cataract surgery. However, both numbers declined in the control group, suggesting that the surgery increased lesion activity. Patients whose surgery occurred in the first 6 months of receiving intravitreal injections were more likely to lose rather than gain vision. Factors that had no discernible influence on VA outcomes included age, type of CNV lesion, and intravitreal injection at least 2 weeks before surgery.
These findings suggest that, when possible, cataract surgery should be avoided in the first 6 months of treatment for neovascular AMD. The authors emphasized that observation is a sensible design for studying the efficacy of cataract surgery because it does not pose the ethical concern of assigning patients who require surgery to a nonsurgical control group.
The original article can be found here.