In Patients with Wet AMD, Cataract Surgery Shown Not to Increase Need for Anti-VEGF Injections

Many patients with age-related macular degeneration (AMD) also have cataract, and both diseases lead to vision loss. Cataract can, however, be surgically cured, and social blindness can be avoided in patients with neovascular (wet) AMD by treating them with intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents such as aflibercept (Eylea/Regeneron) and ranibizumab (Lucentis/Roche).

Despite the success of these treatments, clinicians have been concerned that cataract surgery may increase the risk of AMD progression. Some researchers have estimated that cataract surgery may account for as many as half of all cases of late AMD, though epidemiologic studies have produced conflicting results regarding the association.

To clarify vision outcomes after cataract surgery in patients with wet AMD who were treated with intravitreal anti-VEGF agents in routine clinical practice, a Danish team extracted data on these injections and on cataract surgery from the electronic records databases of two hospitals. They then compared the frequency of anti-VEGF injections before and after surgery. Only patients who received the same anti-VEGF agent before and after cataract surgery were included in the analyses of injection frequency. They also compared visual acuity (measured with electronic charts based on the Early Treatment of Diabetic Retinopathy Study protocol) before and after surgery. Details of the study were published in a recent issue of Acta Ophthalmologica.

In the 89 eyes (of 89 patients) evaluated in this retrospective study, the need for anti-VEGF injections did not change after surgery; the average number of injections needed in the 6 months before surgery was 1.5, compared with 1.7 in the 6 months after surgery (P = 0.25). The median number of anti-VEGF injections before cataract surgery was 10 (range 3—36).

In addition, in the first 6 months after cataract surgery, visual acuity improved by a mean of 7.1 letters (95% confidence interval [CI] 4.6—9.6). Vision improved more when the time from surgery to last injection was shorter rather than longer.

As a result, the investigators concluded that cataract surgery improves vision in patients being treated with anti-VEGF agents for wet AMD, and that cataract surgery is not associated with an increased need for anti-VEGF treatment in these patients. In addition, they found that patients who were in active treatment with an anti-VEGF agent had better visual outcomes after cataract surgery than patients who had surgery well after anti-VEGF treatment had ended.