A study out of Save Sight Institute, Sydney University has concluded that when possible, cataract surgery should be avoided within six months of commencing treatment for neovascular age-related macular degeneration (nAMD).
This is because patients undergoing cataract surgery within the first six months of being treated with anti-VEGF therapy were more likely to lose rather than gain vision. Additionally there was a modest effect of cataract surgery on CNV lesion activity.
The retrospective, matched case-control study was led by Prof. Vincent Daien, current head of the Department of Ophthalmology at the University Hospital of Montpellier, France.
Prof. Daien and his team accessed data from the Fight Retinal Blindness! Project to study 124 eyes undergoing cataract surgery that had been tracked since they first started treatment for nAMD. They compared these eyes with a cohort of 372 unoperated phakic eyes being treated for nAMD, which were matched for treatment duration before cataract surgery; baseline visual acuity (VA); age; and length of follow-up.
The researchers reported, “The mean (95 per cent confidence interval) VA gained was 10.6 letters (7.8, 13.2; P < .001) 12 months after surgery; 26.0 per cent had gained ≥3 lines and 1.6 per cent had lost ≥3 lines of VA. Visual acuity (mean [standard deviation]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs 61.3 [20.8] letters, respectively, P = .018).
“The proportion of visits where the choroidal neovascular (CNV) lesion was graded active and the mean number of injections were similar before and after surgery (P = .506 and P = .316, respectively), whereas both decreased in the control group, suggesting that surgery modestly increased the level of activity of the CNV lesion. Mean [SD] VA prior to surgery was lower in eyes that gained ≥15 letters compared with eyes that gained 0-14 letters (40.2 [21.4] vs 62.1 [15.1], P < .001). Patients undergoing cataract surgery within the first six months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8 per cent lost vision vs 12.8 per cent and 4.4 per cent gaining ≥15 or 0-14 letters respectively, P = .023). Age, receiving an injection at least two weeks before surgery, and the CNV lesion type had no discernible association with VA outcomes.”