Intraoperative complication rates were similar between nAMD eyes and control eyes, but extra care should be taken with these eyes if they’ve had several prior intravitreal injections. Photo: Chakrabarti A, et al. Indian J Ophthalmol. 2017; 65(12):1359-69. Click image to enlarge.

As the population ages, an increasing number of individuals have multiple age-related conditions, such as cataract with comorbid neovascular age-related macular degeneration (nAMD). These two together often make for uncertain prediction of visual potential. To investigate vision outcomes and complications among these eyes, researchers compared nAMD eyes to normal eyes undergoing cataract surgery. In a paper published in the Journal of Cataract and Refractive Surgery, they reported that nAMD eyes had significantly worse visual improvement.

The retrospective, nonrandomized multicenter study included 656 eyes with nAMD and 686 age-matched controls, the largest comparison to-date. Eyes with nAMD had worse preoperative visual acuity than control eyes. Fortunately, no differences in complication rates were found between the two groups for posterior capsule rupture, dropped lens fragments or zonular dialysis. The researchers did, however, report that receiving ≥10 intravitreal anti-VEGF injections before cataract surgery predicted the chances of posterior capsule rupture, with an odds ratio of 2.86.

“We postulate that repeated intravitreal injections in nAMD may be associated with lenticular trauma, possibly leading to less integral support of the capsule structure,” the researchers wrote in their JCRS paper. “Another possibility is the inadvertent iatrogenic trauma to the zonules at the time of injection leading to capsular instability at the time of cataract surgery, possibly increasing the risk of PCR.”

As for visual outcomes, eyes with nAMD had significantly lower visual gains at four to 12 weeks postop than control eyes, with the proportion of eyes achieving three or more Snellen lines 39.2% vs. 63.7%.

Overall, the researchers wrote that their findings suggested that cataract surgery may pose only a modest risk of disease worsening. The researchers observed that eyes requiring more than one intravitreal injection after surgery were significantly fewer in the inactive nAMD group (36%) vs. the active nAMD group (73%). They concluded that “cataract surgery should be considered in patients with nAMD with careful perioperative planning and counseling.”