Outcomes and predictive factors after cataract surgery in patients with neovascular age-related macular degeneration. The Fight Retinal Blindness! Project

Purpose: To evaluate outcomes and predictive factors of visual acuity (VA) change after cataract surgery in patients being treated for neovascular age-related macular degeneration (nAMD). Design: Retrospective, matched case-control study. Methods: We studied eyes undergoing cataract surgery that had been tracked since they first started treatment for nAMD. These eyes were compared with a cohort of unoperated phakic eyes being treated for nAMD (three per case) matched for treatment duration before cataract surgery, baseline VA, age and length of follow-up. Results: We included 124 patients that had cataract surgery and 372 matched controls. The mean (95% CI) VA gained was 10.6 letters (7.8, 13.2; P < 0.001) 12 months following surgery; 26.0% had gained ≥ 3 lines and 1.6% had lost ≥ 3 lines of VA. Visual acuity (mean [SD]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs. 61.3 [20.8] letters respectively, P = 0.018). The proportion of visits where the choroidal neovascular (CNV) lesion was graded active and the mean number of injections were similar before and after surgery (P = 0.506 and P = 0.316, respectively), while both decreased in the control group, suggesting that surgery modestly increased the level of activity of the CNV lesion. Mean [SD] VA prior to surgery was lower in eyes that gained ≥15 letters compared with eyes that gained 0-14 letters (40.2 [21.4] vs. 62.1 [15.1], P < 0.001). Patients undergoing cataract surgery within the first 6 months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8% lost vision vs. 12.8% and 4.4% gaining ≥15 or 0-14 letters respectively, P = 0.023). Age, receiving an injection at least 2 weeks before surgery, and the CNV lesion type had no discernible association with VA outcomes. Conclusions: We found evidence of a modest effect of cataract surgery on CNV lesion activity in eyes being treated for nAMD. Despite this, visual outcomes were reassuringly good. Cataract surgery within 6 months of starting treatment for nAMD should be avoided if possible.The Fight Retinal Blindness Project was supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007-2009), a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-2012) and a grant from the Macula Disease Foundation, Australia. Mark Gillies is a Sydney Medical Foundation Fellow and is supported by an NHMRC practitioner fellowship. Daniel Barthelmes was supported by the Walter and Gertud Siegenthaler Foundation Zurich, Switzerland and the Swiss National Foundation. Vincent Daien was supported by the research grant of the French Society of Ophthalmology and by Servier. Funding was also provided by Novartis and Bayer