Performing cataract surgery in patients with advanced age-related macular degeneration (AMD) may lead to, or worsen, choroidal neovascularization (CNV), according to new research. The procedure could be associated with either the development or exacerbation of CNV, says a report presented at this year’s Association for Research in Vision and Ophthalmology meeting.

The investigators looked into 50 eyes of 36 patients with early, intermediate and quiescent stages of exudative, or “wet” AMD between 2010 and 2016. Twenty-five eyes underwent cataract surgery within two weeks of diagnosis, while the other 25 deferred surgery 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) and central foveal thickness (CFT) using optical coherence tomography (OCT) at baseline and after one, three, six, nine and 12 months.

CNV development was noted in 18 of the 25 eyes that received cataract surgery within two weeks. Half as many patients in the deferred surgery group progressed. The group who underwent surgery sooner also lost 15.0 letters at the final 12-months visit. The group that deferred for a year only lost 5.0 letters.

Antivascular endothelial growth factor (anti-VEGF) injections were performed in cases 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 deferred surgery group received 23 total injections, whereas the early surgery group required 48 injections.

Monaco P, Tollot L, Del Borrello, et al. Cataract surgery and neovascular age- related macular degeneration development or exacerbation: a retrospective analysis. ARVO 2019. Abstract 1139.