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Observational Study
. 2022 Jul;36(7):1379-1383.
doi: 10.1038/s41433-021-01653-4. Epub 2021 Jun 25.

An observational clinical study of the influence of phacoemulsification on choroidal neovascular membrane activity in age related macular degeneration

H D Jeffry Hogg  1   2 , N Chung  3 , J Reed  3 , G Berrett  4 , M Pearce  3 , Sandro Di Simplicio  4
Affiliations
Observational Study

An observational clinical study of the influence of phacoemulsification on choroidal neovascular membrane activity in age related macular degeneration

H D Jeffry Hogg et al. Eye (Lond). 2022 Jul.

Abstract

Background: Thousands of phacoemulsification surgeries are performed on eyes with age-related macular degeneration (AMD) complicated by choroidal neovascular membrane (CNV) in the United Kingdom each year. As populations age this number is expected to rise. Controversy over phacoemulsification's influence on CNV activity limits the information which clinicians and these patients use to decide on surgery. This observational study aims to resolve this controversy by reporting on intravitreal injection (IVI) frequency as a pragmatic marker of CNV activity in a large cohort.

Methods: A cohort of eyes with AMD complicated by CNV (n = 327) that underwent cataract surgery at a single tertiary centre from 2014 to 2019 were identified. These cases were matched by interval since CNV diagnosis at a specified 'time zero' within the follow-up of pseudophakic eyes with AMD (n = 327). Data concerning demographics, visual acuity (VA) and intravitreal injection frequency before and after 'time zero'/phacoemulsification were collected.

Results: Following 'time zero'/phacoemulsification' the mean reduction in annual IVI frequency was 0.6 injections/year (95% CI 0.4,0.9) and 0.4 injections/year (95% CI 0.1,0.7) in the comparison and phacoemulsification cohorts respectively. The mean VA gain 12 months after phacoemulsification in the intervention cohort was 11.3 (95% CI 9.2,13.4) early treatment of diabetic retinopathy study (ETDRS) letters, with 214 eyes (65.4%) having gained ≥5 ETDRS letters after surgery.

Conclusions: Phacoemulsification has no clinically significant impact on the activity of pre-existent CNV secondary to AMD. Phacoemulsification should be offered to patients with AMD and cataract that limits vision, regardless of CNV activity.

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Conflict of interest statement

Prior conference travel grant for HH and SDS from Bayer ™, SDS is paid Key Opinion Leader for Alcon™. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Visual acuity change.
Bar and line histogram showing distribution of visual acuity (VA) gain 12 months following phacoemulsification in 327 eyes with prior choroidal neovascular membrane (CNV) activity secondary to age-related macular degeneration (AMD). ETDRS = early treatment of diabetic retinopathy study.
Fig. 2
Fig. 2. Intravitreal injection frequency change.
Histogram showing the equivocal change in annual intravitreal injection (IVI) frequency observed before and after phacoemulsification or ‘time zero’ in the intervention and comparison cohorts respectively. AMD = age-related macular degeneration, CNV = choroidal neovascular membrane.
See this image and copyright information in PMC

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