The effect of phacoemulsification on the course of concomitant age-related macular degeneration

Comorbidity of age-related cataract and neovascular age-related macular degeneration (nAMD) is a significant problem in ophthalmological practice. The effect of cataract surgery on the course of nAMD and the effectiveness of antiangiogenic (anti-VEGF) therapy remain controversial.

Purpose: to evaluate the effect of phacoemulsification of cataract (PEC) on the course of nAMD.

Material and methods. The retrospective and prospective study included 71 patients (83 eyes) aged 77.85 ± 8.27 years with nAMD and age-related cataract. Of these, PEC with intraocular lens (IOL) implantation was performed in 46 patients. The control group (without PEC) consisted of 25 patients (27 eyes) aged 75.56 ± 6.97 years. Ophthalmologic examination included visual acuity (VA) determination, autorefractometry, biomicroscopy, fundus photography, and optical coherence tomography (OCT), including OCT-angio. Dynamic assessment of the eye condition was performed for at least 12 months before and 12 months after PEC and in the control group.

Results. Three months after PEC, there was a significant improvement in VA compared with the baseline value (mean difference 0.245; p = 0.0001; d = 1.04), which was maintained throughout the entire observation period. In the group without PEC, statistically significant changes in VA were not found over 12 months (p > 0.05). There were no statistically significant differences between the groups in the number of anti-VEGF injections during the 12-month follow-up (2.52 ± 1.96 in the group with PEC and 3.07 ± 0.83 in the control group, p = 0.23). The study of dynamic changes in retinal fluid indicates the absence of statistically significant differences in the state of the structural parameters of the retina, including central retinal thickness (CRT), of patients with nAMD who underwent cataract surgery and patients with nAMD without PEC.

Conclusion. The results of the study do not demonstrate the effect of PEC on the course of nAMD, which is confirmed by the absence of differences in the dynamics of the CRT, the state of the retinal fluid, the number of anti-VEGF injections and visual function indicators.

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