Cataract Surgery Safe, Efficacious in Setting of Wet AMD

by: Pam Harrison
Cataract surgery appears to be safe and efficacious in eyes receiving antivascular endothelial growth factor (VEGF) injections for wet age-related macular degeneration (AMD), a retrospective review suggests. However, patients still need to be carefully monitored, as surgery may increase the risk of developing intraretinal cysts and central retinal thickness.
The study was published online June 18 and in the September issue of the American Journal of Ophthalmology.
“[O]ur results reflect a cautious practice pattern in which only the most stable eyes are allowed to proceed with cataract extraction,” Steven Saraf, MD, from Henry Ford Health Systems, Detroit, Michigan, and colleagues write. “Clinical application of these findings should occur in a similar context as the effect of cataract surgery in uncontrolled wet AMD eyes was not studied and such a study would likely be unethical.”
The investigators compared 40 eyes with wet AMD that underwent cataract surgery with a control group of 42 eyes with wet AMD that did not undergo surgery. The best corrected visual acuity was the same in both groups 3 months before the surgery (0.65 logMAR). However, 3 months after cataract extraction, mean improvement in best corrected visual acuity was significantly better in surgical eyes, which improved by 0.23 log MAR compared with a 0.11 logMAR improvement in nonsurgical eyes (P = .049).
There was no change in the number of anti-VEGF injections given 6 months before surgery (2.31 injections) vs after surgery (2.30 injections) in the surgical group. The date of surgery was considered the midpoint of the study for surgical patients.
Nonsurgical eyes received 3.00 injections before the study midpoint and 2.57 injections after the study midpoint, a decrease that approached statistical significance. The midpoint of the study for the nonsurgical group was defined as halfway through 2012 for patients who were receiving anti-VEGF injections for active wet AMD in that year.
At study outset, there was no significant difference between the two groups of eyes in central thickness, based on optical coherence tomography (OCT) imaging.
However, in the final OCT analysis, there was a significant difference between surgical and nonsurgical eyes in central thickness, with surgical eyes measuring 265.4 μm and nonsurgical eyes measuring 216.4 μm (P = .011) at study end point……
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Source: Medscape