First Author: P.Monaco ITALY
Co Author(s): L. Tollot M. Del Borrello A. Frattolillo F. Sperti D. Poole E. Rapizzi
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To explore whether cataract surgery evokes development or relapse of choroidal neovascularization (CNV) in wet age-related macular degeneration (AMD) patients followed for a 1-year postoperative period.
50 eyes of 36 consecutive patients with different wet AMD stages (early-AMD, intermediate-AMD and quiescent-CNV) and visually significant cataract were retrospectively reviewed in our ophthalmology department between 2010 and 2016. Disciform scarring and geographic atrophy were exclusion criteria.
The study group (25 eyes) underwent cataract surgery within two weeks. The control group (25 eyes) comprised patients who had cataract surgery deferred until the 12-month visit. Each patient underwent best-corrected visual acuity (BCVA) measurement (expressed in LogMAR using ETDRS charts), complete eye examination including digital dynamic fluorescein (FA) and indocyanine green angiography (ICGA) (Heidelberg Engineering) and central foveal thickness (CFT) using optical coherence tomography (OCT) (Spectralis OCT), at baseline and after 1, 3, 6, 9 and 12 months. Antivascular endothelial growth factor (anti-VEGF) injections were performed in case of CNV development or exacerbation detected by fundus exam, FA, ICGA and OCT evaluation. Incidence of neovascular AMD development or exacerbation within 12 months was the primary outcome measure.
The different treatment groups were compared using the Kaplan-Meier (KM) Survival Curves and the Log-Rank Test. The p-value was quite close to significance at the 10% level (p=0.104) probably because of low sample size (low statistical power). The development or exacerbation of choroidal neovascularization was observed in 18 of 25 eyes (72%) in the surgery group versus 9 of 25 eyes (36%) in the deferred surgery group. The study group subjects gained 15.0 letters 1 month after phacoemulsification but lost 15.0 letters at the final 12-months visit vs. 5.0 letters lost for the control group. There was no significant change in foveal thickness in both groups. 2 anti-VEGF injections were performed 10 days before cataract surgery and 48 injections during the follow-up period in the surgery group vs. 23 injections in the deferred group.
In our study, cataract surgery performed in patients with different wet AMD stages could be associated with an increased risk of exacerbation or development of choroidal neovascularization.