Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (？0.04 to 1.32) at 1 month, 0.52 (？0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit ( ). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month ( ). Median CMT measured 203？μm preoperatively, which temporarily increased to 238？μm at 1 month after surgery ( ) and then spontaneously returned to baseline, measuring 212.5？μm at 3 months postoperatively ( ). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively. 1. Introduction Age-related macular degeneration (AMD) and cataract are common ocular disorders in the elderly which often develop concurrently and their prevalence is likely to increase with increasing longevity worldwide. Visually significant cataract may further compromise the vision in patients with AMD. In addition, the formation of cataract may have an impact on the possibility to evaluate the effect of treatment and performing investigations such as optical coherence tomography (OCT) or fundus fluorescein angiography. This impairs monitoring of disease progression. The possibility of a relationship between cataract surgery and progression of AMD has generated considerable debate among ophthalmologists. Several reports have been published which either support [1–8] or reject [9–17] a link between cataract surgery and deterioration of AMD. The strongest evidence supporting development of advanced AMD in the postoperative period was provided by large population-based
References
[1]
C. J. Blair and J. Ferguson Jr., “Exacerbation of senile macular degeneration following cataract extraction,” American Journal of Ophthalmology, vol. 87, no. 1, pp. 77–83, 1979.
[2]
A. Pollack, A. Marcovich, A. Bukelman, and M. Oliver, “Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation,” Ophthalmology, vol. 103, no. 10, pp. 1546–1554, 1996.
[3]
I. Kaiserman, N. Kaiserman, A. Elhayany, and S. Vinker, “Cataract surgery is associated with a higher rate of photodynamic therapy for age-related macular degeneration,” Ophthalmology, vol. 114, no. 2, pp. 278–282, 2007.
[4]
R. Klein, B. E. K. Klein, T. Y. Wong, S. C. Tomany, and K. J. Cruickshanks, “The association of cataract and cataract surgery with the long-term incidence of age-related maculopathy: The Beaver Dam Eye Study,” Archives of Ophthalmology, vol. 120, no. 11, pp. 1551–1558, 2002.
[5]
S. Cugati, P. Mitchell, E. Rochtchina, A. G. Tan, W. Smith, and J. J. Wang, “Cataract surgery and the 10- year incidence of age- related maculopathy: the Blue Mountain Eye Study,” Ophthalmology, vol. 113, no. 11, pp. 2020–2025, 2006.
[6]
J. J. Wang, R. Klein, W. Smith, B. E. K. Klein, S. Tomany, and P. Mitchell, “Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains Eye Studies,” Ophthalmology, vol. 110, no. 10, pp. 1960–1967, 2003.
[7]
E. E. Freeman, B. Munoz, S. K. West, J. M. Tielsch, and O. D. Schein, “Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies,” American Journal of Ophthalmology, vol. 135, no. 6, pp. 849–856, 2003.
[8]
A. Bockelbrink, S. Roll, K. Ruether, A. Rasch, W. Greiner, and S. N. Willich, “Cataract surgery and the development or progression of age- related macular degeneration: a systematic review,” Survey of Ophthalmology, vol. 53, no. 4, pp. 359–367, 2008.
[9]
G. N. Shuttleworth, E. A. Luhishi, and R. A. Harrad, “Do patients with age related maculopathy and cataract benefit from cataract surgery?” British Journal of Ophthalmology, vol. 82, no. 6, pp. 611–616, 1998.
[10]
A. M. Armbrecht, C. Findlay, P. A. Aspinall, A. R. Hill, and B. Dhillon, “Cataract surgery in patients with age-related macular degeneration: one-year outcomes,” Journal of Cataract and Refractive Surgery, vol. 29, no. 4, pp. 686–693, 2003.
[11]
H. Baatz, R. Darawsha, H. Ackermann et al., “Phacoemulsification does not induce neovascular age-related macular degeneration,” Investigative Ophthalmology and Visual Science, vol. 49, no. 3, pp. 1079–1083, 2008.
[12]
F. K. P. Sutter, M. Menghini, D. Barthelmes et al., “Is pseudophakia a risk factor for neovascular age-related macular degeneration?” Investigative Ophthalmology and Visual Science, vol. 48, no. 4, pp. 1472–1475, 2007.
[13]
L. M. Dong, W. J. Stark, J. L. Jefferys et al., “Progression of age-related macular degeneration after cataract surgery,” Archives of Ophthalmology, vol. 127, no. 11, pp. 1412–1419, 2009.
[14]
C. Y. Hooper, E. L. Lamoureux, L. Lim et al., “Cataract surgery in high-risk age-related macular degeneration: a randomized controlled trial,” Clinical and Experimental Ophthalmology, vol. 37, no. 6, pp. 570–576, 2009.
[15]
M. Lundstr？m, K. G. Brege, I. Florén, B. Lundh, U. Stenevi, and W. Thorburn, “Cataract surgery and quality of life in patients with age related macular degeneration,” British Journal of Ophthalmology, vol. 86, no. 12, pp. 1330–1335, 2002.
[16]
E. Y. Chew, R. D. Sperduto, R. C. Milton et al., “Risk of advanced age- related macular degeneration after cataract surgery in the Age—Related Eye Disease Study: AREDS report 25,” Ophthalmology, vol. 116, no. 2, pp. 297–303, 2009.
[17]
F. Forooghian, E. Agrón, T. E. Clemons, F. L. Ferris III, and E. Y. Chew, “Visual acuity outcomes after cataract surgery in patients with age-related macular degeneration: age- related eye disease study report no 27,” Ophthalmology, vol. 116, no. 11, pp. 2093–2100, 2009.
[18]
H. Casparis, K. Lindsley, and N. B. Bressler, “Surgery for cataracts in people with age-related macular degeneration,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD006757, 2009.
[19]
H. Tabandeh, N. A. Chaudhry, D. S. Boyer, V. A. Kon-Jara, and H. W. Flynn Jr., “Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy,” Journal of Cataract and Refractive Surgery, vol. 38, no. 4, pp. 677–682, 2012.
[20]
M. Muzyka-Wo？niak, “Phacoemulsification in eyes with neovascular AMD treated with anti-VEGF injections,” European Journal of Ophthalmology, vol. 21, no. 6, pp. 766–770, 2011.
[21]
P. J. Rosenfeld, H. Shapiro, J. S. Ehrlich, and P. Wong, “Cataract surgery in ranibizumab-treated patients with neovascular age-related macular degeneration from the phase 3 ANCHOR and MARINA trials,” American Journal of Ophthalmology, vol. 152, no. 5, pp. 793–798, 2011.
[22]
A. E. Fung, G. A. Lalwani, P. J. Rosenfeld et al., “An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration,” American Journal of Ophthalmology, vol. 143, no. 4, pp. 566.e2–583.e2, 2007.
[23]
R. F. Degenring, S. Vey, B. Kamppeter, W. M. Budde, J. B. Jonas, and G. Sauder, “Effect of uncomplicated phacoemulsification on the central retina in diabetic and non-diabetic subjects,” Graefe's Archive for Clinical and Experimental Ophthalmology, vol. 245, no. 1, pp. 18–23, 2007.
[24]
M.-L. Bélair, S. J. Kim, J. E. Thorne et al., “Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography,” American Journal of Ophthalmology, vol. 148, no. 1, pp. 128.e2–135.e2, 2009.
[25]
I. Perente, C. A. Utine, C. Ozturker et al., “Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography,” Current Eye Research, vol. 32, no. 3, pp. 241–247, 2007.
[26]
H. N. Shelsta and L. M. Jampol, “PHarmacologic therapy of pseudophakic cystoid macular edema: 2010 update,” Retina, vol. 31, no. 1, pp. 4–12, 2011.
[27]
C. L. Lobo, P. M. Faria, M. A. Soares, R. C. Bernardes, and J. G. Cunha-Vaz, “Macular alterations after small-incision cataract surgery,” Journal of Cataract and Refractive Surgery, vol. 30, no. 4, pp. 752–760, 2004.
[28]
J. B. Jonas, U. H. M. Spandau, F. Schlichtenbrede, T. Libondi, U. Vossmerbaeumer, and S. von Baltz, “Intravitreal bevacizumab combined with cataract surgery for treatment of exudative macular degeneration,” Journal of Ocular Pharmacology and Therapeutics, vol. 23, no. 6, pp. 599–600, 2007.
[29]
C. Furino, A. Ferrara, N. Cardascia et al., “Combined cataract extraction and intravitreal bevacizumab in eyes with choroidal neovascularization resulting from age-related macular degeneration,” Journal of Cataract and Refractive Surgery, vol. 35, no. 9, pp. 1518–1522, 2009.
