Study Adds Fuel to the Debate Over Cataract Surgery and Wet AMD

Cataract surgery was not associated with neovascular (“wet”) age-related macular degeneration (nAMD), even among patients with pre-existing cases of non-neovascular (“dry”) AMD, according to a large retrospective cohort study.

Among two matched groups of more than 122,000 patients, the risk of nAMD was 0.90% at 24 months for patients who underwent cataract surgery compared with 0.79% in control patients (risk ratio [RR] 1.14, 95% CI 1.04-1.24), reported Sumit Sharma, MD, of the Cole Eye Institute at the Cleveland Clinic, and colleagues in a research letter in JAMA Ophthalmology.

“The 95% confidence interval remained within the predefined nonsignificance range, suggesting that the risk ratio was likely a statistical variability rather than a true outcome,” they wrote.

For patients with non-neovascular AMD, a decreased conversion risk was observed at 3 months (RR 0.71, 95% CI 0.56-0.89), “but this decline did not persist at subsequent time points,” the authors noted.

Co-author Victor Bellanda, MD, also of the Cole Eye Institute at the Cleveland Clinic, told MedPage Today that the findings “reinforce that earlier concerns about surgery accelerating AMD progression are likely overstated, particularly when weighed against the visual and quality-of-life benefits cataract surgery can provide.”

As he explained, there’s been extensive debate over the likelihood of nAMD after cataract surgery, with some studies suggesting a higher risk.

“One theory was that removing the natural crystalline lens increases retinal exposure to blue and ultraviolet light, accelerating phototoxic damage to the retinal pigment epithelium,” he explained. “Another hypothesis focused on postoperative inflammation. Cataract surgery induces a transient inflammatory response, and this could create a proangiogenic microenvironment, facilitating VEGF signaling and choroidal neovascularization in susceptible eyes.”

Read More: https://rb.gy/96c846

Source: MEDPAGE Today