Age-related Macular Degeneration after Extracapsular Cataract Extraction with Intraocular Lens Implantation

Pars plana vitrectomy for regression of choroidal neovascularization with age‐related macular degeneration

“…Important features of the surgical procedure described here include: (1) removal of the posterior vitreous membrane that allows tissue fluids, such as subretinal fluid, to diffuse into the vitreous cavity; (2) removal of the posterior vitreous membrane, similar to diffuse diabetic macular edema, that reduces traction in a retinal tangential direction and allows the macular edema to be absorbed (Lewis et al 1992;Wolbarsht & Landers 1980); and (3) an increase in partial oxygen pressure in the vitreous cavity that enhances vasoconstriction with resulting regression of CNV (Hashimoto et al 2000;Pollack et al 1996).…”

“…The characteristics common to these 4 cases were that the patients were elderly (at least 75 years old) and that cataract extraction and intraocular lens implantation were combined with vitrectomy. Recent studies have reported exacerbation of ARMD following cataract surgery with intraocular lens implantation (Pollack et al 1996). Removal of the lens with a resulting increase in the amount of light incident on the macula has been suggested as a possible reason for worsening of ARMD in such cases.…”

Early age-related maculopathy in eyes after cataract surgery

“…Possible mechanisms include retinal inflammatory changes associated with surgery, 10,37 increased light exposure after removal of the lens, 7 and a postoperative biochemical environment in operated eyes (increased free radicals or growth factors), 7,10,38 which could accelerate ARM progression.…”

“…Although earlier case series [6][7][8][9] and a postmortem study 10 suggested a possible association between aphakia or pseudo-phakia and late ARM, the evidence from these studies is relatively weak. Findings from large population-based studies 11,12 appeared to support an association between prior cataract surgery and an increase in late ARM prevalence.…”

“…The strongest evidence to date, came from a pooled data analysis of two large populationbased studies, 13 that showed a significantly increased 5-year incidence of late ARM (odds ratio (OR) 5.7, 95% confidence interval (CI) 2.4-13.6) in nonphakic (aphakic or pseudo-phakic) eyes compared to phakic eyes, after accounting for age, smoking, and the presence and severity of early ARM lesions at baseline. 13 The Beaver Dam Eye Study (BDES) has reported a significant association between cataract surgery performed prior to baseline and the incidence of late ARM after both [5][6][7][8][9][10][11][12][13][14] and 10-year 15 intervals. The potential for an increased late ARM risk after cataract surgery remains topical and controversial, as indicated by two recent editorials published in Archives of Ophthalmology.…”