Insights Into Cataract Surgery Outcomes In Age-Related Macular Degeneration: Real-World Perspectives Across Severity Grades

Leopold Ho Ssl; Shirin Ashraf Vaghefi; Tommes Riemer; Payam Kabiri; Theresa Bonaventura; Anne Ru Bsam; Antonia M Joussen; Oliver Zeitz

doi:10.1016/j.oret.2024.11.018

Insights Into Cataract Surgery Outcomes In Age-Related Macular Degeneration: Real-World Perspectives Across Severity Grades

Ophthalmol Retina. 2024 Nov 28:S2468-6530(24)00575-X. doi: 10.1016/j.oret.2024.11.018. Online ahead of print.

Authors

Leopold Ho Ssl¹, Shirin Ashraf Vaghefi¹, Tommes Riemer¹, Payam Kabiri¹, Theresa Bonaventura¹, Anne Ru Bsam², Antonia M Joussen², Oliver Zeitz³

Affiliations

¹ Department of Ophthalmology, Charité University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health.
² Department of Ophthalmology, Charité University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health; Berlin Institute of Health (BIH), Berlin, Germany.
³ Department of Ophthalmology, Charité University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health; Berlin Institute of Health (BIH), Berlin, Germany. Electronic address: [email protected].

PMID: 39615671
DOI: 10.1016/j.oret.2024.11.018

Abstract

Purpose: Cataract and age-related macular degeneration (AMD) share age as a main risk factor and thus have a high coincidence. Both conditions substantially reduce visual acuity. This study aimed to assess the impact of cataract surgery on visual acuity, retinal morphology, and vascular-endothelial-growth-factor (VEGF) inhibitor therapy in patients with AMD.

Design: This study was designed as a retrospective, monocentric, real-world study.

Subjects: Patients diagnosed with either dry AMD or neovascular AMD undergoing cataract surgery at Charité Campus Benjamin Franklin.

Methods: Treatment data were extracted from the Berlin Macular Registry. Best-corrected visual acuity (BCVA) and macular optical coherence tomography (OCT) parameters, including central retinal thickness (CRT), macular volume (MV), presence of macular edema, intraretinal or subretinal fluid and pigment epithelial detachment were assessed.

Main outcome measures: Primary outcome measure was the postoperative BCVA. Secondary outcomes included postoperative CRT, MV, changes in qualitative OCT parameters, alterations in anti-VEGF-therapy interval and postoperative complications.

Results: A total of 418 eyes of 418 patients were included in the analysis with a mean follow-up time of 18.8 (2-62) months. They were classified into a neovascular AMD (n=85) and a dry AMD (n=333) cohort. Mean BCVA improved significantly in the neovascular AMD cohort from 0.69 ±0.45 logMAR to 0.47 ±0.42 (p= <0.001) and in the dry AMD cohort from 0.53 ±0.47 logMAR to 0.27 ±0.32 (p= <0.001) at the two-month follow-up. Improvements in BCVA were sustained to the final visit (18.9 ±19.5 months post-surgery) with BCVA at 0.46 ± 0.38 logMAR (p= <0.001) and 0.26 ± 0.34 logMAR (p= <0.001), respectively. Temporary postoperative increases in CRT and MV were observed, reverting to preoperative levels by six months post-surgery. The need for anti-VEGF therapy did not change postoperatively in patients with neovascular AMD.

Conclusions: Within this retrospective analysis, on average patients with coincident AMD of all severity grades meeting the inclusion criteria benefited from cataract surgery. Transient increases in retinal thickness and macular volume returned to baseline within six months post-surgery. The need for intravitreal injections in neovascular AMD subjects was unchanged post-surgery. Overall, the study suggests no adverse long-term macular changes attributable to cataract surgery.