Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy

Tabandeh, Homayoun; Chaudhry, Nauman; Boyer, David S.; Konjara, Veronica; Flynn, Harry W.

doi:10.1016/j.jcrs.2011.10.036

Cited by 38 publications

(40 citation statements)

References 17 publications

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“…Furino et al 10 showed favorable results one month after combined phacoemulsification and bevacizumab in an active exudative AMD setting. Tabandeh et al 11 reported similar visual acuity gains in a follow-up period that was shorter than twelve months, in patients that had phacoemulsification whilst being treated with either ranibizumab or bevacizumab. Like Tabandeh et al, we included patients that at the time of the cataract surgery procedure were being treated with either ranibizumab or bevacizumab.…”

Section: -11mentioning

confidence: 85%

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Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration

et al. 2017

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RESUMOIntrodução: Pretendemos avaliar a efectividade e segurança da cirurgia de catarata associada a injecção intravítrea de anti-vascular endothelial growth factor sobre a acuidade visual, morfologia da retina e coróide em doentes previamente tratados por degeneração macular relacionada com a idade exsudativa com cataratas visualmente significativas. Material e Métodos: Estudo prospectivo, que incluiu 21 olhos de 20 doentes com degeneração macular relacionada com a idade exsudativa submetidos a facoemulsificação simultânea com ranibizumab ou bevacizumab intravítreo. Os doentes foram seguidos durante 12 meses após a cirurgia usando uma estratégia pro re nata. As alterações da acuidade visual, espessura da retina e coroideia subfoveal foram avaliadas aos 1, 6 e 12 meses de pós-operatório. Resultados: Houve um aumento estatisticamente significativo da acuidade visual média ao mês (13,4 letras, p < 0,05), aos seis (11,5 letras, p < 0,05) e doze meses (11,3 letras, p < 0,05), sem alterações significativas na morfologia da retina ou coróide. Aos 12 meses, 86% dos olhos foram capazes de manter a melhoria da acuidade visual. Não houve diferenças significativas entre os dois fármacos anti-vascular endothelial growth factor e não ocorreu qualquer complicação durante o seguimento. Discussão: A facoemulsificação associada a injecção intravítrea de anti-vascular endothelial growth factor é segura e permite uma melhoria da acuidade visual em doentes com degeneração macular relacionada com a idade exsudativa e cataratas visualmente significativas. O ganho de acuidade visual foi mantido usando uma estratégia pro re nata mostrando que neste subgrupo de doentes a facoemulsificação pode ser benéfica. Conclusão: A cirurgia de catarata associada a terapia anti-vascular endothelial growth factor simultânea melhora a acuidade visual em doentes com degenerescência macular da idade exsudativa. Palavras-chave: Degeneração Macular; Extração de Catarata; Facoemulsificação; Factores de Crescimento do Endotélio Vascular; Neovascularização; Resultado do Tratamento ABSTRACT Introduction: To evaluate the safety and impact on visual acuity, retinal and choroidal morphology of simultaneous cataract surgery and intravitreal anti-vascular endothelial growth factor on patients with visually significant cataracts and previously treated exudative age-related macular degeneration. Material and Methods:Prospective study, which included 21 eyes of 20 patients with exudative age-related macular degeneration submitted to simultaneous phacoemulsification and intravitreal ranibizumab or bevacizumab. The patients were followed for 12 months after surgery using a pro re nata strategy. Visual acuity, foveal and choroidal thickness changes were evaluated 1, 6 and 12 months post-operatively.Results: There was a statistically significant increase in mean visual acuity at one (13.4 letters, p < 0.05), six (11.5 letters, p < 0.05) and twelve months (11.3 letters, p < 0.05) without significant changes in retinal or choroidal morphology. At 12 months, 86% of eyes wer...

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Section: -11mentioning

confidence: 85%

“…In an era in which exudative AMD can be treated successfully with anti-vascular endothelial growth factor (VEGF) drugs few studies have addressed cataract surgery in patients being treated with these agents. [7][8][9][10][11] It is important to understand the effect of cataract surgery and concomitant anti-VEGF therapy on exudative AMD.…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration

et al. 2017

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“…[18][19][20] Each of these prior analyses was limited to a small cohort of 30 eyes or fewer undergoing cataract surgery with prior IVT. [18][19][20] In this series, we reviewed a cohort of 197 eyes with prior injections along with an equal number of matched control eyes without prior injections. Only eyes with prior injections performed at the Duke Eye Center were included to ensure complete retrospective analysis.…”

Section: Discussionmentioning

confidence: 99%

Rate of intraoperative complications during cataract surgery following intravitreal injections

Hahn

Jiramongkolchai

Stinnett

et al. 2016

Eye

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Purpose To investigate the effect of prior intravitreal injections on intraoperative and postoperative complication rates associated with cataract surgery. Methods A retrospective cohort analysis reviewed 10 105 cataract surgery procedures performed by experienced surgeons at the Duke Eye Center from 1 January 2005 to 10 December 2012. A group of 197 eyes with prior intravitreal injections was compared with an equal number of matched control eyes without prior injection using the Fisher's exact test of difference in proportions and the Wilcoxon rank-sum test of difference in means. Outcomes analyzed included baseline demographic information, preoperative clinical characteristics, prevalence of intraoperative complications, and postoperative intraocular pressure, glaucoma surgery, and glaucoma medication requirement through 1 year following cataract surgery. Results An increased rate of intraoperative complications was identified during cataract surgery in eyes with prior intravitreal injections compared with control eyes (3 vs 0%, P = 0.030). Injection eyes required more glaucoma medications at 1 year, but no difference was identified if steroid injections were excluded. No difference in postoperative IOP or glaucoma surgery was identified. No cases of endophthalmitis were reported. Conclusions A history of intravitreal injections may be a risk factor for cataract surgery-related intraoperative complications. We hypothesize this may be due to unidentified iatrogenic lens trauma during intravitreal injections. Particular attention to the posterior capsule during preoperative assessment and intraoperatively is recommended in eyes undergoing cataract surgery with a prior history of intravitreal injections.

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“…It is known that neovascular AMD, can compromise in 90% of cases severely the vision (20/200 or worse) if left untreated [37], but with the advent of anti-vascular Endothelial Growth Factor (anti-VEGF) intravitreal injections as therapy in wet AMD has got stabilize (90%) or even improved vision (30%) in a large number of cases [38][39][40][41][42][43].…”

Section: Neovascular Amdmentioning

confidence: 99%

“…More recently, studies published have not showed an increase in recurrence, number of injections or worsening of visual acuity when compared with non-operated eyes [15,16,[25][26][27][39][40][41][42][43][50][51][52][53][54][55][56]. However, Lee and cols.…”

Section: Neovascular Amdmentioning

confidence: 99%

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2016

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Age-related cataracts are a worldwide cause of blindness in 10.8 million of people and 35.1 million were visually impaired in 2010, it means that cataract caused 33.4% of blindness and 18.5% of moderate to severe vision impairment [1]. Cataract prevalence increase as people age, by age 75, half of population have a cataract; by age 80, 70% of whites, 53% of Africans and 61% of Hispanics [1,2]. Cataract surgery is a successful procedure in the majority of cases (about 95%) [2]. Although, it is not free of complications, because of the surgical procedure itself or due to coexisting ocular pathology; for example, the global incidence of post surgical cystoid macular edema is about 1.17%, but it is 4-fold increase in eyes with diabetic retinopathy, 5.6-fold in epiretinal membrane and 30-fold in retinal Age related-Macular Degeneration (AMD) is an acquired condition of the retina that causes significant central visual impairment and legal blindness in elderly people [4,5]. In the United States, the prevalence of AMD for people older than 40 years is estimated at 9.2%, then it increases exponentially, reaching 22.8% after 75 years old [6,7]. Recently (2016) an incidence study selected by ethnicity in a population based in the United States was published, finding an overall incidence of 4.1% in Early AMD and 2.3% in late AMD, the white population is the most affected population by 5.3% and 4.1% respectively [3].Thus, cataract and AMD are both age-related conditions that share similar comorbidities (hereditary, cardiovascular risk, free radicals, tobacco, sun exposition, etc.) [5,[8][9][10][11][12]. It is difficult to demonstrate a correlation between cataract surgery and AMD progression or deterioration because of this close relationship. Also, cataract development itself could preclude visualization of posterior pole and prevent a correct diagnosis of AMD [13][14][15][16]. Despite this, concern still exists in ophthalmologists about the behavior of the AMD or the choroidal neovascularization in a patient undergoing cataract surgery.The possible relationship of AMD and cataract surgery was reviewed and discussed. A very extensive searching was made; we analyzed randomized and non-randomized control trials, prospective and clinical trials. We discuss separately each type of AMD following AREDS classification. Likewise, we have intended to extract some recommendations to follow in this complicated scenario according recently clinical evidence. Early-Intermediate AMD and Cataract SurgeryThere are at least four main studies concerning cataract surgery and AMD development, the Beaver Dam Study (BDS), Blue Mountains eye Study (BMS), Rotterdam Eye Study, Los Angeles Latino Eye Study (LALOS). They evaluated the incidence of early manifestations of AMD in patients without signs of AMD at baseline who were submitted to cataract surgery and they did not find a relationship with early AMD.However, there are numerous publications found a possible relationship and they have suggested mechanisms that could lead to progression in AMD ...

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Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy

Abstract: With regular evaluations and appropriate treatment with anti-VEGF agents, cataract surgery did not appear to be associated with an increased incidence of perioperative complications or macular adverse events.

Cited by 38 publications

References 17 publications

Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration

Safety and Effectiveness of Cataract Surgery with Simultaneous Intravitreal Anti-VEGF in Patients with Previously Treated Exudative Age-Related Macular Degeneration

Rate of intraoperative complications during cataract surgery following intravitreal injections

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