Exudation-free period key to cataract surgery success in AMD

By Lucy Piper, Senior medwireNews Reporter

Cataract surgery can benefit patients with exudative age-related macular degeneration (AMD) previously treated with anti-vascular endothelial growth factors (anti-VEGFs) if they have been treated and are exudation-free for more than 12 months, study findings indicate.

For patients with a shorter treatment and exudation-free period before surgery, there is an increased risk of recurrence, researchers Jong Woo Kim (Konyang University College of Medicine, Seoul, South Korea) and team report.

Exudation recurrence is a concern of performing cataract surgery on patients with exudative AMD, note the researchers, so there is value in identifying the influencing factors in order to determine follow-up strategies.

They reviewed the medical records of 39 (39 eyes) patients who underwent cataract surgery following treatment with anti-VEGFs for exudative AMD.

Cataract surgery was performed an average of 23 months after exudative AMD was diagnosed, during which time the patients had received an average of 5.1 intravitreal anti-VEGF injections. The mean exudation-free period was 12.1 months.

Best-corrected visual acuity (BCVA) improved from an average 1.02 (Snellen equivalent of 20/209) before surgery to 0.81 and 0.85 at 1 month and 6 months after surgery, respectively.

At 6 months, 15 (38.5%) eyes had a BCVA improvement of at least 3 Snellen lines and only three (7.7%) eyes had a BCVA loss of at least 3 lines. For the remaining 21 (53.8%) eyes, there was no change in BCVA.

For the 13 patients who experienced exudation recurrence within 6 months of surgery, there was no significant improvement in BCVA.

The researchers note in Graefe’s Archive For Clinical and Experimental Ophthalmology that the average time between exudative AMD diagnosis and cataract surgery was significantly shorter for these patients than for those who did not experience recurrence, at 13.3 months versus 27.9 months.

Similarly, the average exudation-free period before surgery was significantly shorter, at 6.5 months versus 15.2 months.

Indeed, the researchers calculate that patients with an exudation-free period of less than 12 months before surgery had a 2.9 times greater risk of recurrence than patients with longer exudation-free periods.

“Our results suggest that care should be taken when planning cataract surgery in patients recently diagnosed with and/or treated for exudative AMD”, say Kim et al.

“If possible, cataract surgery should not be performed in patients with fewer than 12 months without treatment.”

They add that patients who are within a year of treatment and need immediate cataract surgery to accurately evaluate the macula should be told of the increased risk of exudation and closely monitored after surgery.

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