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Seredyka-Burduk M, Liberski S, Malukiewicz G, Kocięcki J, Kaluzny BJ. Cataract Surgery in nAMD Patients Receiving Intravitreal Aflibercept Injections. J Clin Med 2024; 13:3832. [PMID: 38999398 PMCID: PMC11242468 DOI: 10.3390/jcm13133832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background: To evaluate functional and anatomical outcomesof cataract surgery in neovascular age-related macular neovascularization (nAMD) eyes receiving anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections in modified pro re nata (PRN) regimen. Materials and Methods: Sixty eyes of 60 nAMD patients, including 41 women (68.3%) and 19 men (31.7%) in an average age of 77.35 ± 6.41 years, under treatment with intravitreal aflibercept injections in modified PRN regimen with no signs of macular neovascularization (MNV) activity during two consecutive visits were included in this prospective, observational study. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), as well as the number of anti-VEGF injections were monitored six months before and after phacoemulsification with intraocular lens (IOL) implantation. Further, the change of the abovementioned parameters was assessed during the six-month follow-up period for CRT and the number of injections, while the BCVA was monitored for 54 months. Results: BCVA measured on the first day after surgery (0.17 ± 0.19 logMAR) as well as in the six-month post-surgery (0.13 ± 0.16 logMAR) significantly improved compared to preop values (0.42 ± 0.20 logMAR). BCVA remains stable during the observational period. We found that both differences were statistically significant (p < 0.01). The mean CRT and the mean number of injections did not differ between the six-month pre- and post-surgical periods. Conclusions: We showed the beneficial effect of phacoemulsification in nAMD patients treated with anti-VEGF agents on visual outcomes in the short and long term. Cataract surgery in nAMD eyes treated with anti-VEGF injections does not increase the frequency of anti-VEGF injections and does not cause deterioration of the macular status.
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Affiliation(s)
- Małgorzata Seredyka-Burduk
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Kornela Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
| | - Slawomir Liberski
- Department of Ophthalmology, Poznan University of Medical Sciences, Augustyna Szamarzewskiego 84 Street, 61-848 Poznań, Poland
| | - Grażyna Malukiewicz
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Kornela Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, Augustyna Szamarzewskiego 84 Street, 61-848 Poznań, Poland
| | - Bartlomiej J. Kaluzny
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Kornela Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
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Hanhart J, Wiener R, Totah H, Brosh K, Zadok D. Pseudophakia as a surprising protective factor in neovascular age-related macular degeneration. J Fr Ophtalmol 2023; 46:527-535. [PMID: 36925449 DOI: 10.1016/j.jfo.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 03/18/2023]
Abstract
PURPOSE To assess the impact of lens status on macular function among patients treated for neovascular age-related macular degeneration (nvAMD) in whom scheduled intravitreal injections were delayed. METHODS We reviewed demographic and clinical data as well as macular optical coherence tomographic images of 34 patients (48 eyes) who did not follow their injection schedule during the first wave of COVID-19 in Israel. Functional worsening was defined as a loss of at least 0.1 in decimal best-corrected visual acuity (BCVA). Morphological worsening was defined as new or increased subretinal/intraretinal fluid or a new hemorrhage. OCT indices of quality were used as a measure for cataract density and progression. RESULTS Pseudophakia was associated with a better functional outcome than phakic status: there was a loss of 0.06±0.12 vs. 0.15±0.10 decimal BCVA in the pseudophakic and phakic eyes, respectively (P=.001). A similar trend was observed for morphological changes over the same period: there was an increase in macular thickness of 9±26% vs.12±40%, respectively (P=0.79). During the first wave of COVID-19, the index of OCT quality remained stable for phakic eyes (26±3.6 before the first wave of COVID-19, 26±2.9 afterward; P=1) and pseudophakic eyes (30±2.4 before the first wave of COVID-19, 30±2.6 afterward; P=1). CONCLUSION Pseudophakic eyes with nvAMD that missed their scheduled intravitreal injections experienced fewer morphological and functional complications than phakic eyes with nvAMD.
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Affiliation(s)
- J Hanhart
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel.
| | - R Wiener
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel
| | - H Totah
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel
| | - K Brosh
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel
| | - D Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel, affiliated to the Hebrew University, Jerusalem, Israel
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Choi EY, Kim TY, Lee CS. Predictive Factors for Long-Term Outcomes of Cataract Surgery in Patients Receiving Active Treatment for Neovascular Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10143124. [PMID: 34300289 PMCID: PMC8306055 DOI: 10.3390/jcm10143124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: the safety and efficacy of cataract surgery in eyes with exudative neovascular age-related macular degeneration (nAMD), receiving active treatment, remain unclear. We evaluated the long-term outcomes and associated predictive factors of cataract surgery in eyes with exudative nAMD. Methods: this retrospective cohort study included 65 eyes (61 patients) treated with anti-vascular endothelial growth factor (VEGF) injections within six months preoperatively. Changes in best-corrected visual acuity (BCVA) and anti-VEGF treatment patterns from before to up to four years after surgery were assessed. Predictive factors were identified in association with one-year surgical outcomes. Results: the BCVA improved at six months (p < 0.001) and was maintained for three years postoperatively. The interval between anti-VEGF injections increased 3.4 times postoperatively (p = 0.001). Risk factors for poor BCVA were low preoperative BCVA (p < 0.001) and prolonged nAMD duration (p = 0.003). Prolonged nAMD duration and short exudation-free period were associated with more frequent postoperative anti-VEGF treatments (p = 0.028 and p = 0.003, respectively). AMD subtypes were not associated with both vision and injection pattern outcomes. Conclusions: patients with cataracts receiving nAMD treatment can safely undergo surgery with favorable long-term visual benefits. The preoperative BCVA, nAMD duration, and exudation-free period are potential predictors of surgery outcomes.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul 03722, Korea;
| | - Tae Young Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 06273, Korea;
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-3576
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Management of Cataract in Patients with Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10122538. [PMID: 34201114 PMCID: PMC8228734 DOI: 10.3390/jcm10122538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Cataract and age-related macular degeneration (AMD) are two of the most common eye diseases of aging. This review addresses the pre-operative, intra-operative, and post-operative considerations in managing cataract in patients with age-related macular degeneration. Surgery for visually significant cataracts in patients with AMD can substantially improve the quality of life and reduce the risk of falls. Pre-operative optical coherence tomography is now recommended where possible to identify pre-existing macula disease. Careful counselling of patients is required before cataract surgery, especially with respect to the expected visual outcome, intraocular lens choice and potential risks of surgery. Real-world data has suggested 6 months of intravitreal anti-VEGF therapy for neovascular AMD before cataract surgery is compatible with optimum long-term visual outcomes. Patients receiving intravitreal therapy for neovascular AMD should be advised of the slightly higher risk of intraoperative complications and the surgeon should be prepared to manage these during the operation. During cataract surgery, unnecessary light exposure should be avoided to reduce phototoxicity. Careful planning of intravitreal therapy for neovascular AMD just before cataract surgery allows the eye greater recovery time in the post-operative period before further planned intravitreal therapy.
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Recurring themes during cataract assessment and surgery. Eye (Lond) 2021; 35:2482-2498. [PMID: 33927353 DOI: 10.1038/s41433-021-01548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/01/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
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Figurska M, Bogdan-Bandurska A, Rękas M. Effect of Phacoemulsification on Visual Acuity and Macular Morphology in Patients with Wet Age-Related Macular Degeneration. Med Sci Monit 2018; 24:6517-6524. [PMID: 30220702 PMCID: PMC6154118 DOI: 10.12659/msm.909652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background This article discusses the effectiveness of phacoemulsification cataract surgery with intraocular lens implantation in patients with wet age-related macular degeneration in the inactive phase of the disease. Material/Methods Forty-nine patients (50 eyes) aged 78.94±5.54 years, previously treated with intravitreal injections of anti-vascular endothelial growth factor agents, were qualified for a prospective, randomized 12-month study. The participants were divided into 2 groups. Group I consisted of 25 patients (25 eyes) who were subjected to phacoemulsification cataract surgery. Group II consisted of 24 patients (25 eyes) who were not subjected to phacoemulsification cataract surgery despite having a lens opacity of grade II or higher according to the Lens Opacities Classification System. Results After 12 months of follow-up, patients in group I gained on average 8.04 letters (p<0.001). Furthermore, 20% of the eyes had a significant improvement in best corrected visual acuity of ≥15 Early Treatment of Diabetic Retinopathy Study Chart letters. Patients in group II lost on average 1.96 letters (p>0.05). No significant differences between central retinal thickness values in either group (p>0.05) were noted. The mean number of intravitreal injections of anti-vascular endothelial growth factor agents during the study was 2.64±1.98 in group I and 2.92±2.40 in group II (p>0.05). Conclusions Phacoemulsification performed in eyes with wet age-related macular degeneration during the inactive phase of the disease significantly improves visual acuity. In addition, it does not significantly influence the frequency of intravitreal injections of anti-vascular endothelial growth factor agents or disease activity.
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Affiliation(s)
- Małgorzata Figurska
- Department of Ophthalmology, Military Institute of Medicine, The Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Agnieszka Bogdan-Bandurska
- Department of Ophthalmology, Military Institute of Medicine, The Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Marek Rękas
- Department of Ophthalmology, Military Institute of Medicine, The Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
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Daien V, Nguyen V, Morlet N, Arnold JJ, Essex RW, Young S, Hunyor A, Gillies MC, Barthelmes D. Outcomes and Predictive Factors After Cataract Surgery in Patients With Neovascular Age-related Macular Degeneration. The Fight Retinal Blindness! Project. Am J Ophthalmol 2018; 190:50-57. [PMID: 29550186 DOI: 10.1016/j.ajo.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/16/2022]
Abstract
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 (3 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% confidence interval) VA gained was 10.6 letters (7.8, 13.2; P < .001) 12 months after surgery; 26.0% had gained ≥3 lines and 1.6% had lost ≥3 lines of VA. Visual acuity (mean [standard deviation]) 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 = .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 = .506 and P = .316, respectively), whereas 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 < .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 = .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.
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Affiliation(s)
- Vincent Daien
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nigel Morlet
- Department of Population Health, University of Western Australia, Perth, Australia
| | | | - Rohan W Essex
- Academic Unit of Ophthalmology, Australian National University, Acton, Australia
| | | | - Alex Hunyor
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
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RECURRENCE OF CHOROIDAL NEOVASCULARIZATION LESION ACTIVITY AFTER AFLIBERCEPT TREATMENT FOR AGE-RELATED MACULAR DEGENERATION. Retina 2018; 37:2062-2068. [PMID: 28590316 DOI: 10.1097/iae.0000000000001451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the recurrence rate of choroidal neovascularization (CNV) lesion activity in age-related macular degeneration (AMD) and associated factors after 1-year aflibercept treatment. METHODS Age-related macular degeneration eyes with 1-year aflibercept fixed-regimen treatment and a follow-up period of at least 18 months from the initial aflibercept injection for treatment-naive exudative AMD were retrospectively evaluated. The recurrence rate was examined. Age, gender, visual acuity, AMD subtype, greatest linear dimension, and retinal and choroidal thicknesses at the 12th month examination were compared between eyes with and without recurrence. Presence of remnant polyps and pigment epithelial detachment (PED) morphology were also compared in polypoidal choroidal vasculopathy (PCV) eyes. RESULTS Of the 98 eyes studied, 69 displayed a dry macula at the 12th month examination; 43.7% exhibited recurrence during the subsequent 12-month period in Kaplan-Meier analysis. Although no factors associated with recurrence were detected in AMD, remnant polyps and pigment epithelial detachment morphology at the 12th month examination were significantly associated with recurrence in polypoidal choroidal vasculopathy (P = 0.018 and 0.048, respectively). CONCLUSION Continuous, proactive treatment would be considered overtreatment for more than half of the AMD eyes that achieved a dry macula. Angiography and optical coherence tomography analyses may be useful for predicting recurrence in polypoidal choroidal vasculopathy eyes.
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Ober MD, Fine HF, Saraf SS. Cataract Surgery in Patients With Wet Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2017; 48:700-704. [PMID: 28902329 DOI: 10.3928/23258160-20170829-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arıkan Yorgun M, Toklu Y, Kar ME, Çakmak BH. Effect of cataract surgery in patients with neovascular age-related macular degeneration: further evidence from disciform scars. Int Ophthalmol 2017; 38:459-467. [DOI: 10.1007/s10792-017-0480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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Kessel L, Koefoed Theil P, Lykke Sørensen T, Munch IC. Cataract surgery in patients with neovascular age-related macular degeneration. Acta Ophthalmol 2016; 94:755-760. [PMID: 27255691 DOI: 10.1111/aos.13120] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/07/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the outcome after cataract surgery in patients with neovascular age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections in routine clinical practice. METHODS We extracted information about patients recorded in electronic databases managing anti-VEGF injections and cataract surgery. We compared Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity and frequency of anti-VEGF injections before and after cataract surgery. RESULTS We identified 89 eyes from 89 patients who had cataract surgery after being treated with a median of 10 (range 3-36) anti-VEGF injections for neovascular AMD. Visual acuity improved by a mean of 7.1 [95% confidence interval (CI) 4.6-9.6] ETDRS letters in the first 6 months after cataract surgery. The need of anti-VEGF injections did not change after cataract surgery with an average of 1.5 in the 6 months before surgery versus 1.7 in the 6 months after surgery (p = 0.25). Visual improvement was greater in patients when the time from latest injection to cataract surgery was lower. CONCLUSIONS Cataract surgery improves vision in patients undergoing treatment for neovascular AMD. Cataract surgery was not associated with an increased need for anti-VEGF treatment and patients who were in active anti-VEGF treatment had better visual outcomes than patients who had cataract surgery after long injection-free periods.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology; Roskilde Hospital; Roskilde Denmark
- Department of Ophthalmology; Rigshospitalet - Glostrup; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Torben Lykke Sørensen
- Department of Ophthalmology; Roskilde Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Inger Christine Munch
- Department of Ophthalmology; Roskilde Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Ma Y, Huang J, Zhu B, Sun Q, Miao Y, Zou H. Cost-Utility Analyses of Cataract Surgery in Advanced Age-Related Macular Degeneration. Optom Vis Sci 2016; 93:165-72. [PMID: 26605501 PMCID: PMC4727497 DOI: 10.1097/opx.0000000000000772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the cost-utility of cataract surgery in patients with advanced age-related macular degeneration (AMD). METHODS Patients who were diagnosed as having and treated for age-related cataract and with a history of advanced AMD at the Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, were included in the study. All of the participants underwent successful phacoemulsification with foldable posterior chamber intraocular lens implantation under retrobulbar anesthesia. Best-corrected visual acuity (BCVA) and utility value elicited by time trade-off method from patients at 3-month postoperative time were compared with those before surgery. Quality-adjusted life years (QALYs) gained in a lifetime were calculated at a 3% annual discounted rate. Costs per QALY gained were calculated using the bootstrap method, and probabilities of being cost-effective were presented using a cost-effectiveness acceptability curve. Sensitivity analyses were performed to test the robustness of the results. RESULTS Mean logarithm of the minimum angle of resolution BCVA in the operated eye increased from 1.37 ± 0.5 (Snellen, 20/469) to 0.98 ± 0.25 (Snellen, 20/191) (p < 0.001); BCVA in the weighted average from both eyes (=75% better eye + 25% worse eye) was changed from 1.13 ± 0.22 (Snellen, 20/270) to 0.96 ± 0.17 (Snellen, 20/182) (p < 0.001). Utility values from both patients and doctors increased significantly after surgery (p < 0.001 and p = 0.007). Patients gained 1.17 QALYs by cataract surgery in their lifetime. The cost per QALY was 8835 Chinese yuan (CNY) (1400 U.S. dollars [USD]). It is cost-effective at the threshold of 115,062 CNY (18,235 USD) per QALY in China recommended by the World Health Organization. The cost per QALY varied from 7045 CNY (1116 USD) to 94,178 CNY (14,925 USD) in sensitivity analyses. CONCLUSIONS Visual acuity and quality of life assessed by utility value improved significantly after surgery. Cataract surgery was a cost-effective intervention for patients with coexistent AMD.
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Saraf SS, Ryu CL, Ober MD. Reply: To PMID 26095263. Am J Ophthalmol 2015; 160:1312-3. [PMID: 26411632 DOI: 10.1016/j.ajo.2015.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
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Kim JH. The Effects of Cataract Surgery on Patients With Wet Macular Degeneration. Am J Ophthalmol 2015; 160:1312. [PMID: 26422829 DOI: 10.1016/j.ajo.2015.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
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Kessel L, Erngaard D, Flesner P, Andresen J, Tendal B, Hjortdal J. Cataract surgery and age-related macular degeneration. An evidence-based update. Acta Ophthalmol 2015; 93:593-600. [PMID: 25601333 PMCID: PMC6680180 DOI: 10.1111/aos.12665] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/13/2014] [Indexed: 11/24/2022]
Abstract
Purpose Age‐related macular degeneration (AMD) and cataract often coexist in patients and concerns that cataract surgery is associated with an increased risk of incidence or progression of existing AMD has been raised. This systematic review and meta‐analysis is focused on presenting the evidence concerning progression of AMD in patients undergoing cataract surgery. Methods We performed a systematic literature search in the PubMed, Medline, Cochrane Library and CINAHL databases. Two randomized trials and two case–control trials were identified. Quality of the studies was assessed using the Cochrane risk of bias tool, data were extracted, and meta‐analyses were performed. Quality of the available evidence was evaluated using the GRADE system. Results We found that visual acuity at 6–12 months follow‐up was significantly better (6.5–7.5 letters) in eyes that had undergone cataract surgery than in unoperated eyes, but the included number of subjects was small, and hence, the quality of evidence was downgraded to moderate. We did not find an increased risk of progression to exudative AMD 6–12 months after cataract surgery [RR 3.21 (0.14–75.68)], but the included number of subjects was small, and thus, the quality of the evidence was moderate. Conclusion Cataract surgery increases visual acuity without an increased risk of progression to exudative AMD, but further research with longer follow‐up is encouraged.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology Copenhagen University Hospital Glostrup Glostrup Denmark
- Danish Health and Medicines Authority Copenhagen Denmark
| | - Ditte Erngaard
- Department of Ophthalmology Næstved Hospital Næstved Denmark
| | | | | | - Britta Tendal
- Danish Health and Medicines Authority Copenhagen Denmark
- The Nordic Cochrane Center Rigshospitalet Copenhagen Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology Aarhus University Hospital NBG Aarhus Denmark
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