Study investigates effects of cataract surgery on AMD
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Patients with age-related macular degeneration who are undergoing cataract surgery should be seen within 4 weeks after surgery and appropriately treated within 14 days if required.
“It is possible that cataract surgery may reactivate wet AMD or make dry AMD turn wet,” Kavita Aggarwal, MD, said at the virtual European Society of Cataract and Refractive Surgeons winter meeting.
In a retrospective cohort study, all patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections over 1 year in a district general hospital setting in the U.K. were examined. A total of 4,133 cataract operations and 6,149 injections for AMD were performed over that time span, and 106 patients received injections for wet AMD at any time, either before or after cataract surgery. Data collected included the development of subretinal or intraretinal fluid, the number of injections, best corrected visual acuity and central retinal thickness (CRT).
“On average, patients were seen 4 weeks after cataract surgery. Looking at patients with no history of injections who developed wet AMD, we found eight of 106 patients who became wet (7.5%) following cataract surgery. The mean time to activation was 75.38 days, ranging from 31 to 183 days, and the average time from suspicion of wet AMD to injection was 11.6 days, ranging from 0 to 28 days,” Aggarwal said.
Cataract surgery did not change CRT or did not change it significantly, nor did it change central subfield thickness in eyes with preoperative fluid. Vision was better after surgery despite the development of wet AMD. When activation or reactivation occurred, mean visual acuity was 0.40 as compared with 0.47 preoperatively, Aggarwal said.
Among patients who already had wet AMD and had been injected any time before surgery, 17% did not reactivate after at least 12 months after cataract surgery. However, the injection interval decreased overall, from 7.15 weeks preop to 6.7 weeks postop, and 71.7% of patients required more injections postoperatively.
Of the patients with wet AMD who were stable before surgery, only four (3.77%) reactivated after cataract surgery, and the average time between surgery and injection was 165 days, ranging from 48 to 423 days.
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Aggarwal K. Should having cataract surgery affect follow-up appointments in patients with wet AMD? Presented at: European Society of Cataract and Refractive Surgeons winter meeting; Feb. 19-21, 2021 (virtual meeting).
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