Cataract Surgery In Exudative Age-Related Macular Degeneration – A Trigger For Disease Activity?

Exudative age-related macular degeneration (AMD) and senile cataract frequently coexist and cause significant impact on patients’ visual impairment. However, timing for cataract surgery remains controversial in these patients due to concerns about exudative AMD exacerbation. The purpose of this study is to investigate how cataract surgery affects disease activity on exudative AMD patients and to report functional outcomes.

Single centre, retrospective, observational and longitudinal study of selected patients diagnosed with exudative AMD undergoing cataract surgery at Egas Moniz Hospital, Western Lisbon Hospital Center (Portugal).

Retrospective review of patient’s medical records with exudative AMD who underwent cataract surgery during 2017-2021. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were examined at: diagnosis, last visit prior to cataract surgery, 3- and 6-months postoperatively. None of the patients presented disease activation at last observation before surgery. The total number of intravitreal injections of Anti-vascular endothelial growth factor (anti-VEGF) injections were recorded during the 6-months pre- and postoperative period. Eye clinical characteristics, past medical and ocular history, and intra- and postoperative complications were analysed.

Fifty eyes of 50 patients were included in this study (mean age 80.5±5.2 years). CFT reduced after cataract surgery (258.2±53.0μm preoperatively to 257.5±74.1μm at 3-months postoperatively, p<0.001, and to 245.5±58.1μm at 6-months, p=0.003). Additionally, BCVA improved considerably (1.27±0.79 logMAR preoperatively to 0.64±0.55 at 3-months postoperatively, p=0.001, and to 0.58±0.51 at 6-months, p=0.003). Ten (20.0%) patients developed signs of disease activation in 6-months follow-up, however, anti-VEGF treatment burden decreased after cataract surgery (21.2% decrease in 6-months pre- and postoperatively). Two (4.0%) patients had intraoperative posterior capsular rupture, yet none of them developed exudative AMD activation.

Despite concerns about exudative AMD progression induced by cataract surgery, cataract advancement in these patients may greatly reduce their visual function and hinder treatment due to diminished visibility of the retina. This report demonstrates that cataract surgery does not cause overall disease worsening and offers significantly improved BCVA 6-months after surgery. Even though some patients revealed disease activation after surgery, this risk may be considered of low magnitude when potential improvement in visual acuity and quality of life is expected.