This retrospective matched case control study evaluated outcomes and predictive factors of visual acuity (VA) change after cataract surgery in patients being treated for neovascular age related macular degeneration (nAMD). They compared 124 patients that had cataract surgery with 372 matched controls (three per case). The patients were matched for treatment duration, baseline VA and length of follow-up. The mean VA gained was 10.6 letters (P<0.001) 12 months after surgery; 26.0% had gained ≥3 lines and 1.6% had lost ≥3 lines of VA. Visual acuity (mean [standard deviation]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs. 61.3 [20.8] letters, respectively, P=.018). There was some suggestion that surgery increased the activity of the choroidal neovascularisation (CNV) lesion as the proportion of visits and injections in the patients who had cataract surgery stayed the same before and after surgery but decreased in the control group. They also found that patients undergoing cataract surgery within the first six months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8% lost vision vs. 12.8% gaining >15 letters and 4.4% gaining 0-14 letters). They concluded that there was a modest effect of cataract surgery on CNV lesion activity in eyes being treated for nAMD. However, visual outcomes are reassuringly good. In addition cataract surgery should be avoided within six months of starting treatment for nAMD. There are several limitations of this study. There was selection bias in relation to the decision to operate on the cataract and no details were available on the grade of cataract, rationale of surgery or complications of the surgery.
Cataract surgery in patients being treated for neovascular AMD
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