Author: Francisco Javier Moreno-Aleman Sanchez (Spain)
Co-authors: Marta Belmonte Grau, Muxima Patricia Acebes Garcia
To evaluate macular fluid before and after cataract surgery in patients undergoing treatment for age-related macular degeneration. Setting/Venue: Urban Tertiary hospital. Hospital Universitario de la Princesa. Madrid
Urban Tertiary hospital. Hospital Universitario de la Princesa, Madrid
We conducted a retrospective study of 550 patients undergoing phacoemulsification cataract surgery in the macula section of an Urban Tertiary hospital, Hospital Universitario de la Princesa, Madrid (Spain). 83 of those initial participants were also AMD patients treated with intravitreal injections. Demographic and clinical data of these patiens were colleted : age, gender, operated eye, presence of risk factors for surgery (mature cataract, pseudo-exoliation syndrome, poor dilatation and posterior subcapsular cataract), the experience of the surgeon (less or more than 5 years), presence of intra-surgical complications (posterior capsule rupture, zonular disinsertion or dislocation of the lens to the vitreous nucleus),time phacoemulsification surgery took place( whether it was in the first 6 months after the beginning of the intravitreal injections, or in a later period of their lifes), number of injections received prior to cataract surgery ( 10 or more), visual acuity (VA) ( Logmar) before and 6 months after de surgery and neovascular membrane activity status. This activity was determined by the presence of intraretinal fluid (IRF) and / or subretinal fluid (SRF) through structural OCT images before and at least 4 weeks after the surgery.
83 patients (15%) had received prior intravitreal injections. 57 were women (68%) and 26 men (31.3%). The average age was 84.5 years. 39 were rigth eyes(47%) and 44 were left eyes (53%). There was an increase between preoperative and 6 months postoperative visual acuity (logmar VA: 0.73 , logmar VA: 0.38). 80% of the surgeries were performed by expert surgeons and the majority of patients (88%) had received more than 10 intravitreal injections before the cataract surgery was performed. 45.8% of the patients had no activity one month before surgery but 54.2% had either SRF (15.7%) or IRF (28.9%) or both (9.6%). In the group of patients in which the membrane was no active before surgery (38), 23,6% (9) suffered a reactivation. One month after surgery, 62.7% of the patients had neovascular membrane activity, being those patients with both types of activity (IRF and SRF) who increased more (9.6% versus 18.1%). In the subanalysis of the type of macular fluid, 6 out of the 13 patients with SRF (46.15%) presented an increase in fluid quantity.
Cataract surgery is one of the most frequent procedures performed in industrialized countries and intravitreal treatment for AMD has increased exponentially in recent years. Both are bound to be found more and more prevalent in the future, even more so taking into account the aging of the population, as our study shows, where the mean age of the patients was 85 years.More than half of our patients presented neovascular membrane activity before cataract surgery, included those who had been with intravitreal treatment longer than 6 months. There were no significant differences in final postoperative VA between patients with or without reactivation, probably due to an increase in SRF that would less affect the visual acuity than the presence of IRF. Patients with preoperative macular fluid in OCT should be considered for cataract surgery, since these patients visually evolved well despite the presence of fluid, avoiding lengthening the number of intravitreal injections with the risk of future complications in cataract surgery