AMD type has no impact on timing of cataract surgery
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Timing of cataract surgery did not affect outcomes among patients with wet age-related macular degeneration, according to a study published in Acta Ophthalmologica.
“Timing of cataract surgery in wet AMD patients should be adjusted according to patients’ needs,” Petteri Karesvuo, MD, a PhD student at Helsinki Retina Research Group and the department of ophthalmology at Helsinki University Hospital, and colleagues wrote. “We found no justification to support delaying surgery until dry macula has been achieved. Surgery should, therefore, not be postponed for these considerations in patients who require it.”
This retrospective registry-based study included 111 eyes with wet AMD that underwent cataract surgery between 2014 and 2018. The mean age of patients at time of surgery was 78.9 years. Karesvuo and colleagues analyzed best-corrected visual acuity and central subfield macular thickness at the time of wet AMD diagnosis, at the last recording before cataract surgery and again at first recording and 1 year following surgery. They recorded anti-VEGF injections at surgery, systemic and topical medication and postoperative anti-VEGF burden.
In almost all eyes studied, central subfield macular thickness decreased (280.1 ± 75.0 µm preoperatively to 268.6 ± 67.6 µm at the first postoperative recording, P = .001; and to 265.9 ± 67.9 µm at 1 year, P = .003), visual acuity improved (0.7 ± 0.46 logMAR preoperatively to 0.39 ± 0.4 at the first postoperative recording, and to 0.33 ± 0.34 at 1 year, P < .001 for both) and anti‐VEGF treatment intervals lengthened (6.53 ± 2.08 weeks prior to surgery to 7.03 ± 2.23 weeks at 1 year, and to 7.05 ± 2.57 weeks at the last documented visit, P = .035).
The researchers found macular status, wet AMD subtype, pre-diagnosis of type 2 diabetes, systemic and topical anti‐inflammatory medication were not associated with macular changes or with treatment intervals after surgery.
“Our study supports performing cataract surgery regardless of wet AMD activity when a potential improvement in visual acuity can be expected,” Karesvuo and colleagues wrote. “Neither the macular status prior to surgery nor the cumulative number of anti‐VEGF injections was associated with clinical outcomes postoperatively.”
Perspective
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Both wet AMD and cataracts can severely impact visual function, especially when they coexist. Both conditions also progress without intervention; therefore, it is important for the optometric clinician to recognize appropriate treatment and surgical protocol.
This retrospective cohort study evaluated wet AMD patients who underwent cataract surgery for stability vs. progression in terms of central subfield macular thickness (CSMT). It is important to note that the patients received intervals of anti-VEGF treatment at time of diagnosis — between 4 to 6 weeks prior to cataract surgery — and postoperatively as indicated. Overall, CSMT was reduced from baseline values at the postoperative and 1-year follow-up windows, leading to the conclusion that cataract surgery does not adversely affect the patient’s wet AMD status.
The authors also concluded that cataract surgery did not significantly influence the incidence of hemorrhage, pigment epithelial detachments, intra or subretinal fluid postoperatively or at 1-year follow-up, further supporting that cataract surgery should not be postponed for patients who require it.
Some limitations to this study include a relatively small cohort size, a short follow-up endpoint of 1 year and a lack of structured data accumulation during the postoperative window (timing varied for CSMT measurements during postoperative visits). Even so, the results strongly support that postponing cataract surgery due to the presence of wet AMD is unnecessary, and doing so may adversely affect the patient’s quality of life. Best clinical practice would be to organize retina care prior to cataract surgery, adjust the timing of cataract surgery to each individual patient’s needs, and recognize that a successful surgical outcome is one based on macular disease stability and achievement of modified visual goals.
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