AMD and cataract
Cataract patients with AMD require close follow-up
Kavita Aggarwal MBBS, MSc, FRCOpth
Cataract surgery can induce wet age-related macular degeneration (AMD) in a minority of dry AMD patients and may reactivate the condition in patients in whom the condition is quiescent. Patients with previously diagnosed or suspected AMD therefore require close follow-up after cataract procedures, suggests Kavita Aggarwal MBBS, MSc, FRCOpth, John Radcliffe Hospital, Oxford, UK.
In a retrospective cohort study, Dr Aggarwal and her associates reviewed all patients who underwent cataract surgery and were receiving intravitreal anti-vascular endothelial growth factor injections from December 1 2017 to November 30 2018 at Amersham/Stoke Mandeville hospitals. During that period 4,133 cataract operations and 6,149 injections for AMD were performed, Dr Agarwal told the 25th ESCRS Winter Meeting.
In total, 106 patients received injections for wet AMD at any time, either preceding or after cataract surgery. Of those patients, eight (7.5%) developed wet AMD following cataract surgery, having never previously received intravitreal injections preoperatively. The mean time to activation was 75.38 days (range 31-183 days). Average time from suspicion of wet AMD to injection was 11.6 days (range 0-28), she said.
Of the patients with previously treated but stable wet AMD there were 18 in whom cataract surgery did not reactivate the condition over a follow-up of at least 12 months postoperatively, Dr Aggarwal said. Of those patients, eight had received injections over a period of more than six months and 10 had received the injection over a period less than six months. In four patients with stable wet AMD and who had not required injections for more than six months, the condition returned after a mean of 165 days (range 48-423 days). In addition, 71.7% required more intravitreal injections postoperatively. The average interval between injections decreased from 7.15 weeks preoperatively to 6.7 weeks postoperatively.
Dr Aggarwal noted that visual acuity improved by a mean value of -0.13 logMAR with a range of change -0.88 to +0.44. In addition, BCVA at presentation of reactivation wet AMD was logMAR 0.40 compared to a preoperative acuity of logMAR 0.47.
“In this cohort, preoperative dry AMD patients who do reactivate are appropriately treated within 14 days according to the Royal College of Ophthalmologists guidelines for wet AMD. Telephone and virtual follow-up may affect this in the future as demand increases,” Dr Aggarwal added.