Age-related macular degeneration after extracapsular cataract extraction with intraocular lens implantation

Poor visual outcome and associated factors among patients underwent cataract surgery at Debre Markos and Felege Hiwot comprehensive specialized hospitals, Northwest Ethiopia, 2023

OBJECTIVE

This study aimed to determine the proportion of poor visual outcome and associated factors among adult patients who underwent cataract surgery at Debre Markos and Felege Hiwot Comprehensive Specialized Hospitals in northwestern Ethiopia in 2023.

METHODS

A hospital based cross-sectional study was conducted on 418 adult patients who had undergone cataract surgery from June 07 to August 07, 2023. Patients were recruited using systematic random sampling with an interval of 2. A pre-tested semi-structured questionnaire, medical record review, and ophthalmologic examination were used to collect data. The collected data was entered into Epi-info version 7 and exported to SPSS version 25 software for analysis. Binary logistic regression was used to determine the factors associated with poor visual outcomes of cataract surgery. Variables with a p-value of less than 0.05 in the multivariable binary logistic regression were considered statistically significant.

RESULTS

A total of 408 study participants with a median age of 65 years and a response rate of 97.6% took part. The proportion of poor visual outcomes of cataract surgery from 4 weeks to one year was 25.7% (95%CI: 21.6%, 30.3%). Factors responsible for poor visual outcomes of cataract surgery were intraocular lens implantation without a posterior chamber (AOR = 2.91, 95%CI:1.46,5.80), per-existing central corneal opacity (AOR = 3.83, 95%CI:1.52,9.69), pseudoexfoliation (AOR = 3.91,95%CI:1.39,11.88), age-related macular degeneration(AOR = 3.75, 95%CI:1.22, 11.88), glaucoma (AOR = 3.11, 95%CI:1.06,9.17) and striate keratopathy(AOR = 3.4, 95%CI: 1.11, 10.88).

CONCLUSION

In this study, the proportion of poor visual outcomes of cataract surgery is higher than the World Health Organization recommendation. The study found that implantation of an intraocular lens without a posterior chamber, pre-existing central corneal opacity, pre-existing age-related macular degeneration, pre-existing glaucoma, pseudoexfoliation, and striate keratopathy were significantly associated with poor visual outcomes of cataract surgery. We recommend that ophthalmologists and cataract surgeons prioritize the reduction of surgical complications and pre-existing ocular co-morbidities to enhance post-operative visual acuity. Improving pre-operative assessment and refining surgical techniques like phacoemulsification will aid in achieving this goal.

Three-Month Safety and Efficacy Outcomes for the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT™)

The smaller-incision new-generation implantable miniature telescope (SING IMT™) is the second generation of the IMT™, a telescope prosthesis that is indicated for monocular implantation in patients with stable vision impairment caused by bilateral central scotomas associated with end-stage Age-related macular degeneration (AMD). This non-comparative retrospective study is the first and largest single-surgeon case series to evaluate the short-term (3 months) safety and efficacy of the device in patients with disciform scars or geographic atrophy at baseline. The main outcome measures included best-corrected distance and near visual acuity (CDVA and CDNVA, respectively), endothelial cell density (ECD) loss, and the incidence of complications. At postoperative month 3 in the study eyes, mean CDVA and CDNVA improved by +14.9 ± 7.1 letters and +7.7 ± 3.2 Jaeger levels, respectively. Importantly, 70.83% of patients gained ≥ 2 lines, 58.33% ≥ 3 lines, and 25.00% ≥ 4 lines of CDVA. From baseline, ECD loss in the study eyes was 10.4 ± 13.3% at 3 months, however, ECD was comparable between the study and fellow eyes at all time points. The most common complication was corneal edema. In all, these short-term outcomes suggest that the SING IMT™ delivers lower ECD loss than the first-generation IMT ™, but similar visual outcomes and safety.

Effect of cataract surgery on the progression of age-related macular degeneration

BACKGROUND

Cataracts and age-related macular degeneration (AMD) are common causes of decreased vision and blindness in individuals over age 50. Although surgery is the most effective treatment for cataracts, it may accelerate the progression of AMD, so this study further evaluated the influence of cataract surgery for AMD through a systematic review and meta-analysis.

METHODS

The Cochrane Systematic Evaluation method was adopted, and computer searches were conducted for the China Knowledge Network, Wanfang, Vipul, SinoMed, PubMed, SpringerLink, Clinicalkey, Medline, Cochrane Library, Web of Science, OVID, and Embase databases of cohort studies on the impact of cataract surgery on AMD, with search timeframes up to May 2022. Meta-analysis was performed using Stata/12.0.

RESULTS

A total of 8 cohort studies were included in the study. The results showed that the relative risk (RR) of AMD progression after cataract surgery was not significantly different, RR 1.194 [95% credibility interval (CI) 0.897-1.591]; the risk remained increased more than 5 years after surgery, RR 1.372 (95% CI 1.062-1.772).

CONCLUSION

There is still a significant positive correlation between cataract surgery and increase the risk of worsening of AMD progression, and faster progression of early-to-late AMD found in cataract surgery with longer follow-up of patients.

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

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.

Association between conventional or blue-light-filtering intraocular lenses and survival in bilateral cataract surgery patients

Circadian rhythms regulate adaptive alterations in mammalian physiology and are maximally entrained by the short wavelength blue spectrum; cataracts block the transmission of light, particularly blue light. Cataract surgery is performed with two types of intraocular lenses (IOL): (1) conventional IOL that transmit the entire visible spectrum and (2) blue-light-filtering (BF) IOL that block the short wavelength blue spectrum. We hypothesized that the transmission properties of IOL are associated with long-term survival. This retrospective cohort study of a 15-hospital healthcare system identified 9,108 participants who underwent bilateral cataract surgery; 3,087 were implanted with conventional IOL and 6,021 received BF-IOL. Multivariable Cox proportional hazards models that included several a priori determined subgroup and sensitivity analyses yielded estimates supporting that conventional IOL compared with BF-IOL may be associated with significantly reduced risk of long-term death. Confirming these differences and identifying any potential causal mechanisms await the conduct of appropriately controlled prospective translational trials.

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Risk of all-cause mortality in 9,108 patients after bilateral cataract surgery

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Comparison of conventional intraocular lenses to blue-light-filtering intraocular lenses

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Conventional lenses that transmit the entire visible spectrum may improve survival

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Glaucoma patients particularly may benefit from conventional intraocular lenses

Does Cataract Surgery Improve the Progression of Age-Related Macular Degeneration? A Meta-Analysis

Purpose

Cataract and age-related macular degeneration (AMD) are the common causes of blindness in the elderly. Although cataract surgery is the most effective treatment for cataract, some clinicians suspect that such interventions may accelerate the progression of AMD. Therefore, we carried out this meta-analysis to focus on demonstrating the effectiveness and safety of cataract surgery in eyes with AMD.

Methods

We performed a systematic literature search in the PubMed, EMBASE, and Cochrane Library databases, and the electronic databases were last searched in January 2019. We planned to include cohort trials of eyes affected by both cataract and AMD in which cataract surgery would be compared to no surgery. Two reviewers independently evaluated the search results against the inclusion and exclusion criteria. 8 trials were included for this meta-analysis.

Results

We used the Stata/12.0 to integrate the data that was extracted from the articles. Eight cohort trials with data from different study populations were included. In random effects model, the relative risk (RR) for the progression of AMD is 1.194 (95% CI 0.897–1.591). As for those grouped according to the follow-up year, the RR for longer than five years was 1.372 (95% CI 1.062–1.772).

Conclusion

We could draw out such a conclusion that there is still a positive correlation between cataract surgery and the progression of AMD, especially for the Asians. However, based on the current results, it is not possible to draw conclusions from existing studies on the impact of cataract surgery on early AMD development.

Cataract Surgery and the 6-year Incidence of Age-Related Macular Degeneration in a Multiethnic Asian Cohort

PURPOSE

The aim of this study was to determine whether cataract surgery was associated with age-related macular degeneration (AMD) development in Asian patients.

DESIGN

Longitudinal cohort study.

METHODS

Participants from the Singapore Malay and Indian Eye Studies were recruited between 2004 and 2015. A total of 6790 late-AMD-free eyes from 3475 individuals were followed for 6 years on average. Multivariable regression analysis using generalized estimating equations determined associations between cataract surgery and the incidence of any, early, and late AMD.

RESULTS

The mean age (SD) of participants was 55.5 (9.1) years; 48.1% were male; 11.3% of eyes had cataract surgery recorded; incident any, early, and late AMD developed in 238 (3.6%), 222 (3.4%), and 29 (0.4%) eyes, respectively. Operated eyes had higher incidence of late AMD [1.4% vs 0.3%; adjusted risk ratio (RR): 3.47, 95% confidence interval (CI) 1.40-8.57], but not early AMD (6.0% vs 3.0%, adjusted RR: 1.12, 95% CI 0.76-1.64) or any AMD (6.9 vs 3.2%, adjusted RR: 1.23, 95% CI 0.85-1.78).

CONCLUSIONS

Our data are consistent with findings in population-based Caucasian studies that cataract surgery may be associated with incidence of late AMD. However, the absolute risk of late AMD development remains low and physicians should continue to balance the benefits and risks of cataract surgery in elderly patients.

First-Year Outcomes of Cataract Surgery Combined with Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration

Objectives

To compare the first-year results of patients with active neovascular age-related macular degeneration (nAMD) under intravitreal ranibizumab (IVR) treatment who did and did not undergo cataract surgery.

Materials and Methods

The records of 72 patients with active nAMD were reviewed retrospectively. Group 1 consisted of 23 patients who underwent uncomplicated cataract surgery and continued with IVR treatment and group 2 consisted of 49 patients without cataract who received only IVR treatment. The groups were compared according to pretreatment and first year best spectacle-corrected visual acuity (BCVA), central foveal thickness (CFT), number of injections, and nAMD activity (presence of subretinal or intraretinal fluid). Logarithm of minimum angle of resolution (LogMAR) was used for the determination of visual acuity. Activity findings were evaluated with optical coherence tomography.

Results

Pretreatment BCVA was 0.94±0.21 in group 1 and 0.77±0.36 in group 2 (p=0.041). At the end of the first year, BCVA was 0.48±0.35 in group 1 and 0.49±0.33 in group 2 (p=0.902). BCVA change was 0.46±0.29 in group 1 and 0.28±0.31 in group 2 (p=0.026). Pretreatment CFT was 305±146 μm in group 1 and 340±120 μm in group 2 (p=0.292). At the end of the first year, CFT was 246±110 μm and 245±82 μm in group 2 (p=0.977). CFT change was 59±45 μm in group 1 and 92±97 μm in group 2 (p=0.135). Mean number of injections over 1 year was 6.2±1.9 in group 1 and 5.7±1.8 in group 2 (p=0.271). At the end of the first year, subretinal fluid was observed in 3 patients in group 1 (13%) and 5 patients in group 2 (10.2%) (p=0.721) and intraretinal fluid was present in 3 patients in group 1 (13%) and 4 patients in group 2 (8.2%) (p=0.515).

Conclusion

Cataract surgery combined with IVR treatment yielded significant visual gain in patients with active nAMD. Anatomic results suggest that cataract surgery does not worsen nAMD.

Changes in macular vasculature after uncomplicated phacoemulsification surgery: Optical coherence tomography angiography study

PURPOSE

To use optical coherence tomography (OCT) angiography and a split-spectrum amplitude-decorrelation angiography algorithm to evaluate the changes in the macular vascular system after uncomplicated phacoemulsification.

SETTING

Department of Ophthalmology, Eye and and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective case series.

METHODS

Patients with senile cataracts were included. Retinal vessel density and thickness at the macular area were checked by OCT at baseline and at 1 week, 1 month, and 3 months after cataract surgery.

RESULTS

Thirty-two eyes (32 patients) were included in the final analysis. There was a significant increase in retinal vessel density, a decrease in the foveal avascular zone at the macular area after the cataract surgery (all P < .05, repeated-measures analysis of variance), and an increase in full and inner macular thickness, all of which extended to the end of the follow-up period. At 3 months postoperatively, there was a mean 6% and 3% increase in vessel density at the parafoveal and perifoveal regions, respectively, and a mean 27% reduction in the foveal avascular zone. The mean increase in inner retinal thickness was 15%, 10%, and 7% at the fovea, parafovea, and perifovea, respectively. Compared with the parafovea and perifovea, the fovea had a much higher percentage of change in retinal vasculature and inner retinal thickness (all P < .001).

CONCLUSIONS

Macular vessel density and thickness increased after cataract surgery. Whether these changes will persist over a longer period still needs to be studied.

Prevention of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) compromises quality of life. However, the available therapeutic options are limited. This has led to the identification of modifiable risk factors to prevent the development or alter the natural course and prognosis of AMD. The identification and modification of risk factors has the potential for greater public health impact on reducing morbidity from AMD. Likewise, identifying the imaging clues and genetic clues could serve as a guide to recognizing the propensity for progression to severe and end stages of the disease. Several attempts, both successful and unsuccessful, have been made for interventions that could delay the progression of AMD. Of these, pharmacological interventions have shown promising results. The Age-Related Eye Disease Study 1 and 2 have shown the beneficial role of antioxidants in a selected group of patients.

Surgery for cataracts in people with age-related macular degeneration

BACKGROUND

Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision.

OBJECTIVES

The objective of this review was to evaluate the effectiveness and safety of cataract surgery compared with no surgery in eyes with AMD.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 December 2016.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-randomized trials that enrolled participants whose eyes were affected by both cataract and AMD in which cataract surgery was compared with no surgery.

DATA COLLECTION AND ANALYSIS

Two review authors independently evaluated the search results against the inclusion and exclusion criteria. Two review authors independently extracted data, assessed risk of bias for included studies, and graded the certainty of evidence. We followed methods as recommended by Cochrane.

MAIN RESULTS

We included two RCTs with a total of 114 participants (114 study eyes) with visually significant cataract and AMD. We identified no ongoing trials. Participants in each RCT were randomized to immediate cataract surgery (within two weeks of enrollment) or delayed cataract surgery (six months after enrollment). The risk of bias was unclear for most domains in each study; one study was registered prospectively.In one study conducted in Australia outcomes were reported only at six months (before participants in the delayed-surgery group had cataract surgery). At six months, the immediate-surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed-surgery group (mean difference (MD) -0.15 LogMAR, 95% confidence interval (CI) -0.28 to -0.02; 56 participants; moderate-certainty evidence). In the other study, conducted in Austria, outcomes were reported only at 12 months (12 months after participants in the immediate-surgery group and six months after participants in the delayed-surgery group had cataract surgery). There was uncertainty as to which treatment group had better improvement in distance visual acuity at 12 months (unit of measure not reported; very low-certainty evidence).At 12 months, the mean change from baseline between groups in cumulated drusen or geographic atrophy area size was small and there was uncertainty which, if either, of the groups was favored (MD 0.76, 95% CI -8.49 to 10.00; 49 participants; low-certainty evidence). No participant in one study had exudative AMD develop in the study eye during 12 months of follow-up; in the other study, choroidal neovascularization developed in the study eye of 1 of 27 participants in the immediate-surgery group versus 0 of 29 participants in the delayed-surgery group at six months (risk ratio 3.21, 95% CI 0.14 to 75.68; 56 participants; very low-certainty evidence). Quality of life was measured using two different questionnaires. Scores on the Impact of Vision Impairment (IVI) questionnaire suggested that the immediate-surgery group fared better regarding vision-related quality of life than the delayed-surgery group at six months (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59; low-certainty evidence). However, we could not analyze scores from the Visual Function-14 (VF-14) questionnaire from the other study due to insufficient data. No postoperative complication was reported from either study.

AUTHORS' CONCLUSIONS

At this time, it is not possible to draw reliable conclusions from the available data as to whether cataract surgery is beneficial or harmful in people with AMD after 12 months. Although cataract surgery provides short-term (six months) improvement in BCVA in eyes with AMD compared with no surgery, it is unclear whether the timing of surgery has an effect on long-term outcomes. Physicians must make recommendations to their AMD patients regarding cataract surgery based on experience and clinical judgment until large controlled trials are conducted and their findings published.There is a need for prospective RCTs in which cataract surgery is compared with no surgery in people with AMD to better evaluate whether cataract surgery is beneficial or harmful in all or a subset of AMD patients. However, ethical considerations preclude withholding surgery, or delaying it for several years, if it may be a potentially beneficial treatment. Designers of future trials are encouraged to utilize existing standardized systems for grading cataract and AMD and for measuring key outcomes: visual acuity, change in visual acuity, worsening of AMD, quality of life measures, and adverse events.

Optimizing cataract surgery in patients with age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of visual impairment. The development of cataract in AMD patients poses challenges in assessing timing of surgery, predicting potential benefit to the patient of surgery, and predicting short- and long-term effects of surgery on progression of their AMD. Although traditional cataract surgery remains the mainstay of treatment, recently several devices have been developed to address the specific needs of AMD patients with cataract. We look at the associations between cataract and AMD and outline the treatment approaches to cataract surgery in AMD, looking at the potential benefits and risks of both traditional approaches and newer devices. We provide clinicians treating patients with AMD and cataract with a framework for choosing the appropriate management.

Evaluation of choroidal thickness changes after phacoemulsification surgery

Purpose

The aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT).

Methods

In this prospective study, 38 eyes of 38 patients having phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including preoperative axial length (AXL) measurement with optical biometry and intraocular pressure (IOP) measurement preoperatively and 1 month postoperatively. The CT was measured perpendicularly at the fovea and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal using SD-OCT preoperatively and 1 month postoperatively. Changes in the CT after surgery and correlation of this change with age, AXL, preoperative IOP, and IOP change were evaluated.

Results

There was a statistically significant increase in the CT at all regions evaluated. This increment was more prominent in the nasal and subfoveal regions. The IOP decreased significantly 1 month after surgery (16.14±4.94 mmHg vs 13.91±4.86 mmHg; P<0.001). The change in IOP was correlated with the CT changes at all regions, whereas age, AXL, and preoperative IOP had no significant correlations with the changes in CT.

Conclusion

Phacoemulsification surgery may cause significant increase in CT, which is correlated with surgery-induced IOP change in the short term. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

Cataract surgery and age-related macular degeneration. An evidence-based update

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.

The effects of cataract surgery on patients with wet macular degeneration

PURPOSE

To explore whether cataract surgery contributes to the progression of wet age-related macular degeneration (wet AMD).

DESIGN

Retrospective cohort study.

METHODS

Retrospective review was performed of consecutive patients with wet AMD who underwent cataract surgery at the midpoint of a 1-year study window. A control arm included wet AMD eyes treated with anti-vascular endothelial growth factor (VEGF) injections that did not undergo cataract surgery for a 1-year period. Best-corrected visual acuity (BCVA), number of anti-VEGF injections, and optical coherence tomography (OCT) features were compared between the 2 arms.

RESULTS

Forty eyes in the surgical group and 42 in the nonsurgical group were included. BCVA was equivalent in the first half of the study, and became significantly better in the surgical group vs the nonsurgical group (0.23 ± 0.65 vs 0.11 ± 0.59 logMAR improvement, P = .049). There was no change in the number of injections given 6 months before vs after the midpoint in the surgical group (P = .921). The mean OCT central retinal thickness became greater in postsurgical eyes compared to nonsurgical eyes (265.4 ± 98.4 μm vs 216.4 ± 58.3 μm, P = .011). Surgical eyes were more likely to develop new or worse cystoid changes after the study midpoint (13 surgical eyes [54.2%] vs 9 nonsurgical eyes [28.1%], P = .048).

CONCLUSIONS

Cataract surgery leads to vision improvement and does not appear to contribute to worsening of wet AMD. However, anatomic changes based on OCT analysis suggest a subclinical susceptibility to postoperative cystoid macular edema or exacerbation of choroidal neovascularization.

Comparison of intravitreal ranibizumab between phakic and pseudophakic neovascular age-related macular degeneration patients: Two-year results

Background and objective

To compare the efficacy of intravitreal ranibizumab (IVR) for the treatment of neovascular age-related macular degeneration (nAMD) between phakic and pseudophakic eyes after a follow-up of two years.

Materials and methods

Data were analyzed retrospectively. The newly diagnosed and treatment naïve nAMD patients were included in the study. The patients were divided into two subgroups: phakic group, and pseudophakic. All patients received 3 consecutive monthly IVR injections, and then the treatment was continued on an as-needed regimen. Patients were examined monthly, and the data at the baseline, at month 6, 12, 18, and 24 were evaluated. The changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of injections were compared between the two groups.

Results

The study included 92 eyes of 87 patients (58 phakic, 34 pseudophakic). Mean logarithm of the minimal angle of resolution (LogMAR) VA at the baseline, and at month 6, 12, 18, and 24 was 0.89, 0.74, 0.75, 0.73, and 0.75, in the phakic group; and 0.79, 0.71, 0.66, 0.70, and 0.70 in the pseudophakic group, respectively. The change in mean BCVA from the baseline to month 6, 12, 18, and 24 was not statistically different between the two groups (p = 0.4, p = 0.9, p = 0.5, p = 0.6, respectively). Mean injection number at month 24 was 7.9 and 8.1 in the phakic and pseudophakic group, respectively (p = 0.7).

Conclusion

Intravitreal ranibizumab treatment on an as-needed treatment regimen is effective in preserving vision and improving central retinal thickness in both the phakic and pseudophakic group of nAMD patients. The functional and anatomical outcomes of the treatment, and the number of injections were similar in the phakic and pseudophakic nAMD patients after a follow-up time of 24 months.

The impact of cataract surgery on AMD development and progression

Age-related macular degeneration (AMD) and cataract are two leading causes of visual impairment worldwide which often occur concurrently in the same patient. With more than 1.6 million cataract operations performed per year in the United States, many of which occur in the nearly 1.75 million individuals diagnosed with AMD, there is ample incentive to further explore the interaction between these two conditions. Notably, the role of cataract surgery on AMD development and progression is of particular interest. This review summarizes the major findings from literature focusing on the effect of cataract surgery on AMD.

Perioperative retina evaluation of the cataract surgery patient

PURPOSE OF REVIEW

To describe recent evidence regarding cataract surgery in patients with coexisting retinal disease, focusing on factors that are important to the perioperative evaluation and treatment of this patient population.

RECENT FINDINGS

Studies in patients with age-related macular degeneration have yielded good visual gains without progression of neovascular disease or increased need for intravitreal antivascular endothelial growth factor therapy. Uveitic patients similarly gain vision on average, and control of inflammation remains paramount. Perioperative treatment with intravitreal antivascular endothelial growth factor and corticosteroid help mitigate postoperative macular edema in patients with diabetic macular edema. Risk of retinal detachment is elevated postcataract surgery, but evidence regarding prophylactic treatment of peripheral retinal pathology is lacking. Intracameral antibiotics have reduced rates of postcataract surgery endophthalmitis in recent population-based retrospective studies.

SUMMARY

Favorable visual acuity outcomes are possible following cataract surgery in patients with retinal disease, including uveitis, diabetic macular edema, and age-related macular degeneration. Perioperative control of retinal disease activity is desired, but level 1 evidence to guide best practices regarding optimal timing and nature of perioperative treatment remains limited. Prevention of postoperative retinal detachment and endophthalmitis is deserving of additional study.

Huynh N, Nicholson BP, Agrón E, Clemons TE, Bressler SB, Rosenfeld PJ, Chew EY. Visual acuity after cataract surgery in patients with age-related macular degeneration: age-related eye disease study 2 report number 5

OBJECTIVE

To evaluate visual acuity outcomes after cataract surgery in persons with varying degrees of severity of age-related macular degeneration (AMD).

DESIGN

Cohort study.

PARTICIPANTS

A total of 1232 eyes of 793 participants who underwent cataract surgery during the Age-Related Eye Disease Study 2, a prospective, multicenter, randomized controlled trial of nutritional supplements for treatment of AMD.

METHODS

Preoperative and postoperative characteristics of participants who underwent cataract extraction during the 5-year trial were analyzed. Both clinical data and standardized red-reflex lens and fundus photographs were obtained at baseline and annually. Photographs were graded by a centralized reading center for cortical and posterior subcapsular lens opacities and for AMD severity. Cataract surgery was documented at annual study visits or by history during the 6-month telephone calls. Analyses were conducted using multivariate repeated-measures regression.

MAIN OUTCOME MEASURES

Change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.

RESULTS

Adjusting for age at time of surgery, gender, interval between preoperative and postoperative visits, and type and severity of cataract, the mean changes in visual acuity were as follows: eyes with mild AMD (n = 30) gained 11.2 letters (95% confidence interval [CI], 6.9-15.5), eyes with moderate AMD (n = 346) gained 11.1 letters (95% CI, 9.1-13.2), eyes with severe AMD (n = 462) gained 8.7 letters (95% CI, 6.7-10.7), eyes with noncentral geographic atrophy (n = 70) gained 8.9 letters (95% CI, 5.8-12.1), and eyes with advanced AMD (central geographic atrophy, neovascular disease, or both; n = 324) gained 6.8 letters (95% CI, 4.9-8.8). The visual acuity gain across all AMD severity groups was statistically significant from preoperative values (P < 0.0001).

CONCLUSIONS

Mean visual acuities improved significantly after cataract surgery across varying degrees of AMD severity.

Phacoemulsification surgery in eyes with neovascular age-related macular degeneration

Purpose. To evaluate the visual outcomes and effect of phacoemulsification surgery on the progression of neovascular age-related macular degeneration (AMD). Methods. Retrospective, noncomparative, and interventional case series. Thirty eyes from 29 subjects with neovascular AMD treated with intravitreal antivascular endothelial growth factor (VEGF) injections who underwent phacoemulsification and had a postsurgery follow-up of 6 months were included. LogMAR best corrected visual acuity (BCVA) was assessed preoperatively; 1 month, 3 months, and 6 months postoperatively; and finally at the last visit. The frequency of anti-VEGF therapy, calculated as the number of intravitreal injections per month, and central macular thickness (CMT) before and after cataract surgery were determined. Results. Median (range) logMAR BCVA was 0.69 (0.16 to 1.32) preoperatively; 0.55 (-0.04 to 1.32) at 1 month, 0.52 (-0.1 to 1.32) at 3 months, and 0.50 (0.0 to 1.32) at 6 months postoperatively; and 0.6 (0.0 to 1.4) at final visit (P = 0.0011). There was no difference in the frequency of anti-VEGF injections between the immediate 6 months before and after phacoemulsification, which was equal to 0.1667 injections per month (P = 0.6377). Median CMT measured 203  μ m preoperatively, which temporarily increased to 238  μ m at 1 month after surgery (P = 0.0093) and then spontaneously returned to baseline, measuring 212.5  μ m at 3 months postoperatively (P = 0.3811). Conclusion. Phacoemulsification surgery significantly improved vision in patients with neovascular AMD, with no increased need for anti-VEGF injections to keep the macula dry postoperatively.

Changes in choroidal thickness after cataract surgery

PURPOSE

To evaluate changes in choroidal thickness before and after cataract surgery and factors affecting the changes.

SETTING

Tsukazaki Hospital, Himeji, Japan.

DESIGN

Prospective interventional study.

METHODS

Patients having cataract surgery without other eye pathology were studied. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), axial length (AL), and enhanced-depth-imaging optical coherence tomography (OCT) were measured preoperatively. The choroidal thickness was measured at 5 points (subfoveal and 1.5 mm nasal, temporal, superior, and inferior to the fovea) using the OCT device's software. Enhanced-depth-imaging OCT and IOP measurements were obtained 3 days, 1 and 3 weeks, and 3 and 6 months postoperatively and compared with the baseline values. Stepwise analysis determined which factors (ie, age, CDVA, preoperative IOP, AL, operative time, changes in IOP) were associated with changes in choroidal thickness.

RESULTS

One hundred eyes were analyzed. The postoperative IOP significantly decreased at 3 weeks, 3 months, and 6 months. The postoperative choroidal thickness significantly increased at the foveal and inferior regions throughout the follow-up; at the nasal region at 3 days, 1 week, and 6 months; at the temporal region at 1 week; and at the superior region at 6 months. These changes negatively correlated with those in IOP early after surgery. The changes in choroidal thickness later negatively correlated with the AL in all regions.

CONCLUSION

Cataract surgery caused changes in choroidal thickness. The AL and changes in the IOP are critical for evaluating the changes in choroidal thickness.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Monitoring of drusen and geographic atrophy area size after cataract surgery using the MD3RI tool for computer-aided contour drawing

BACKGROUND/AIMS

To monitor possible changes in the cumulated drusen or geographic atrophy area size (CDGAS) of nonexudative age-related macular degeneration (AMD) in patients before and after cataract surgery, using a new tool for computer-aided image quantification.

METHODS

Randomized, prospective, clinical trial. 54 patients with cataract and nonexudative AMD were randomly assigned into an early surgery group (ES = 28) and a control group (CO = 26) with a 6-month delay of surgery. CDGAS was determined with the MD3RI tool for contour drawing in a central region of digitized fundus photographs, measuring 3,000 µm in diameter. To evaluate CDGAS progression, differences in pixels and square millimeters were calculated by equivalent tests.

RESULTS

Forty-nine patients completed the visits over the 12-month period (ES = 27 and CO = 22). Mean pixel values increased from 201.5 (11.33 × 10(-3) mm(2)) to 202.7 (11.39 × 10(-3) mm(2)) in the ES group and from 191.6 (10.77 × 10(-3) mm(2)) to 194.6 (10.94 × 10(-3) mm(2)) in the CO group. Finally, equivalence of CDGAS differences between ES and CO could be demonstrated. No exudative AMD was recorded during the study period.

CONCLUSION

In our cohorts, no significant changes were found in CDGAS 12 months after cataract surgery. The MD3RI software could serve as an efficient, precise and objective tool for AMD quantification and monitoring in future trials.

Risk of age-related macular degeneration 3 years after cataract surgery: paired eye comparisons

OBJECTIVE

To clarify possible associations between cataract surgery and progression of age-related macular degeneration (AMD).

DESIGN

Clinic-based cohort.

PARTICIPANTS

We followed cataract surgical patients aged 65+ years in the Australian Cataract Surgery and Age-related Macular Degeneration (CSAMD) study. Patients who remained unilaterally phakic for at least 24 months after recruitment were included.

METHODS

We performed annual examinations with retinal photography. We assessed AMD using side-by-side grading of images from all visits. Paired comparisons between operated and nonoperated fellow eyes (defined as nonoperated or operated <12 months previously) were made using generalized estimating equation models.

MAIN OUTCOME MEASURES

Incident early AMD was defined as the new appearance of soft indistinct/reticular drusen or coexisting retinal pigmentary abnormality and soft distinct drusen in eyes at risk of early AMD. Incident late AMD was defined as the new appearance of neovascular AMD or geographic atrophy (GA) in eyes at risk of late AMD.

RESULTS

Among 2029 recruited, eligible participants, 1851 had cataract surgery performed at Westmead Hospital, Sydney, and 1244 (70.7%) had 36-month postoperative visits. Of these participants, 1178 had gradable photographs at baseline and at least 1 follow-up visit. Of 308 unilaterally operated participants at risk of late AMD, this developed in 4 (1.3%) operated and 7 (2.3%) nonoperated fellow eyes (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.23-2.36) after adjusting for the presence of early AMD at baseline. Of 217 unilaterally operated participants at risk of early AMD, this developed in 23 (10.6%) operated and 21 (9.7%) nonoperated fellow eyes (OR, 1.07; 95% CI, 0.74-1.65). Incident retinal pigment abnormalities were more frequent in operated than nonoperated fellow eyes (15.3% vs. 9.9%; OR, 1.64; 95% CI, 1.07-2.52). There was no difference in the 3-year incidence of large soft indistinct or reticular drusen between the 2 eyes (8.8% vs. 7.9%; OR, 1.12; 95% CI, 0.79-1.60).

CONCLUSIONS

Prospective follow-up data and paired eye comparisons of this older surgical cohort showed no increased risk of developing late AMD, early AMD, or soft/reticular drusen over 3 years. There was a 60% increased detection of retinal pigmentary changes in surgical eyes.

Surgery for cataracts in people with age-related macular degeneration

BACKGROUND

Cataract and age-related macular degeneration (AMD) are common causes of decreased vision that often occur simultaneously in people over age 50. Although cataract surgery is an effective treatment for cataract-induced visual loss, some clinicians suspect that such an intervention may increase the risk of worsening of underlying AMD and thus have deleterious effects on vision.

OBJECTIVES

The objective of this review was to evaluate the effectiveness and safety of cataract surgery in eyes with AMD.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 4), MEDLINE (January 1950 to April 2012), EMBASE (January 1980 to April 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to April 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 16 April 2012.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) and quasi-randomized trials of eyes affected by both cataract and AMD in which cataract surgery would be compared to no surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently evaluated the search results against the inclusion and exclusion criteria. Two authors independently extracted data and assessed risk of bias for included studies. We resolved discrepancies by discussion.

MAIN RESULTS

One RCT with 60 participants with visually significant cataract and AMD was included in this review. Participants were randomized to immediate cataract surgery (within two weeks of enrollment) (n = 29) or delayed cataract surgery (six months after enrollment) (n = 31). At six months, four participants were lost to follow-up; two participants from each group. The immediate surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed surgery group at six months (mean difference (MD) 0.15 LogMAR, 95% confidence interval (CI) 0.28 to 0.02). There was no significant difference in the development of choroidal neovascularization between groups (1/27 eyes in the immediate surgery group versus 0/29 eyes in the delayed surgery group). Results from Impact of Vision Impairment (IVI) questionnaires suggested that the immediate surgery group faired better with quality of life outcomes than the delayed surgery group (MD in IVI logit scores 1.60, 95% CI 0.61 to 2.59). No postoperative complication was reported. We identified a second potentially relevant study of immediate versus delayed cataract surgery in 54 people with AMD. Results for the study are not yet available, but may be eligible for future updates of this review.

AUTHORS' CONCLUSIONS

At this time, it is not possible to draw reliable conclusions from the available data to determine whether cataract surgery is beneficial or harmful in people with AMD. Physicians will have to make practice decisions based on best clinical judgment until controlled trials are conducted and their findings published.It would be valuable for future research to investigate prospective RCTs comparing cataract surgery to no surgery in patients with AMD to better evaluate whether cataract surgery is beneficial or harmful in this group. However ethical considerations need to be addressed when delaying a potentially beneficial treatment and it may not be feasible to conduct a long-term study where surgery is withheld from the control group. Utilization of pre-existing, standardized systems for grading cataract and AMD and measuring outcomes (visual acuity, change in visual acuity, worsening of AMD and quality of life measures) should be encouraged.

Phacoemulsification in eyes with neovascular AMD treated with anti-VEGF injections

PURPOSE

To evaluate visual results of phacoemulsification in eyes with neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF) intravitreal injections.

METHODS

This retrospective noncomparative interventional case-series study assessed best-corrected visual acuity (BCVA) at 4 timepoints: 1) baseline, immediately before first anti-VEGF injection; 2) preoperative, immediately before phacoemulsification; 3) postoperative, 1 month after phacoemulsification; 4) endpoint, at the last visit. Anti-VEGF retreatment regimen was based only on optical coherence tomography. The median time between anti-VEGF injections was evaluated for the time period before and after phacoemulsification.

RESULTS

Sixteen eyes of 16 patients were included. The median (range) baseline, preoperative, postoperative, and endpoint BCVA was 0.7 (0.3-1.3), 0.72 (0.4-1.3), 0.5 (0.05-1.0), and 0.36 (0.0-1.0) logMAR, respectively. Best-corrected visual acuity significantly improved after phacoemulsification (mean 3 logMAR lines) and remained stable during follow-up (median 14 months, range 7-28). There was no statistically significant difference in the median time interval between injections before phacoemulsification and after phacoemulsification.

CONCLUSIONS

Phacoemulsification significantly improved BCVA in patients with choroidal neovascular AMD. This effect persisted during follow-up with no increased need for anti-VEGF injections to keep macula dry.

Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy

PURPOSE

To evaluate the visual outcomes, choroidal neovascular complex status, and adverse events in patients with visually significant cataract and neovascular age-related macular degeneration (AMD) who had cataract surgery.

SETTING

Private practices, Beverly Hills, California, and New London, Connecticut, USA.

DESIGN

Case series.

METHODS

Data were abstracted from the medical records of patients with neovascular AMD treated by anti-vascular endothelial growth factor (anti-VEGF) therapy who had cataract surgery. The main outcome measures were Snellen corrected distance visual acuity (CDVA), perioperative adverse events, and status of the choroidal neovascular complex.

RESULTS

The study enrolled 30 eyes of 28 patients. The CDVA was 20/40 or better in 10% of eyes preoperatively and 40% postoperatively; 20/50 to 20/100 in 53% and 33%, respectively; and 20/200 or worse in 37% and 27%, respectively. The change in CDVA from preoperatively to postoperatively was statistically significant, with a mean change of 0.22 logMAR ± 0.27 (SD) at 2 months (P<.0001), 0.22 ± 0.36 logMAR at 6 months (P=.001), and 0.17 ± 0.54 logMAR at the last follow-up (P=.01). Patients received a mean of 0.32 injections per month postoperatively compared with 0.49 injections per month preoperatively. Perioperative macular adverse events did not occur in any eye.

CONCLUSIONS

With regular evaluations and appropriate treatment with anti-VEGF agents, cataract surgery did not appear to be associated with an increased incidence of perioperative complications or macular adverse events.

Cataract surgery in ranibizumab-treated patients with neovascular age-related macular degeneration from the phase 3 ANCHOR and MARINA trials

PURPOSE

To investigate whether cataract surgery was beneficial in patients with neovascular age-related macular degeneration (AMD) receiving monthly ranibizumab injections in the ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) and MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD) phase 3 trials.

DESIGN

Retrospective analysis.

METHODS

Patients were identified who underwent cataract surgery during the 2 pivotal trials. For this analysis, the best-corrected visual acuity (VA) just prior to cataract surgery was referred to as the redefined baseline VA. For the period after cataract surgery, endpoints included change in VA, time to first postsurgery injection, and total number of injections. Monthly follow-up visits after surgery were defined at 30-day intervals ± 15 days.

RESULTS

Three subgroups were identified: study eyes of ranibizumab-treated patients (758 eyes [23 undergoing surgery]), fellow eyes of ranibizumab-treated patients (758 eyes [28 undergoing surgery]), and eyes of non-ranibizumab patients (762 [16 undergoing surgery]). Three months postsurgery, the VA of ranibizumab-treated eyes improved by a mean of 10.4 (± 3.4) letters compared to the redefined baseline (n = 20; 95% confidence interval +3.3 letters to +17.5 letters). The mean VA change from redefined baseline VA was not significantly different between the 3 groups at any of the evaluated time points postsurgery (P > .44 for all comparisons between each pair of the 3 groups at 1, 2, 3, and 4 months following surgery).

CONCLUSIONS

In the phase 3 trials, cataract surgery appeared to be safe and beneficial for all eyes with AMD, including ranibizumab-treated eyes with neovascular AMD. An average VA improvement of more than 2 lines was typically observed.

Macular pigment changes in pseudophakic eyes quantified with resonance Raman spectroscopy

PURPOSE

We examined changes in macular pigment optical density (MPOD) levels after cataract surgery and compared the MPOD between eyes with clear intraocular lenses (IOLs) and yellow-tinted IOLs.

DESIGN

Prospective, comparative case series.

PARTICIPANTS

The MPOD levels were measured in 480 eyes of 337 patients after cataract surgery. Among them, the data from 259 eyes (clear IOL group, 121 eyes; yellow-tinted IOL group, 138 eyes) of 259 Japanese patients were selected for statistical analyses on the basis of the inclusion criteria: a postoperative visual acuity (VA) of ≥0.8 and no fundus diseases. Only 1 eye of each patient was enrolled. Patients provided informed consent to participate in this study on the basis of the approval of the institutional review board before surgery.

METHODS

The patients selected the type of IOL to be implanted. The MPOD levels were measured using resonance Raman spectroscopy on day 1 (baseline value); months 1, 3, and 6; and years 1 and 2 postoperatively.

MAIN OUTCOME MEASURES

The difference in MPOD levels between the IOL groups was analyzed by unpaired t tests. The following parameters were analyzed by multiple regression analysis: age, gender, body mass index (BMI), smoking history, glaucoma, diabetes, preoperative VA, preoperative refractive error, and IOL power and type.

RESULTS

We found no significant differences in the baseline characteristics between the 2 groups. Until 6 months postoperatively, the MPOD levels did not differ significantly between the groups. However, from 1 year onward, the levels were significantly higher in the yellow-tinted IOL group compared with the clear IOL group. By multiple regression analysis, 1 day postoperatively, older age and diabetes were correlated with lower MPOD levels; 1 year postoperatively and thereafter, however, lower MPOD levels were correlated with clear IOLs.

CONCLUSIONS

Cataract surgery with clear IOLs induced a greater decrease in macular pigment levels compared with yellow-tinted IOLs during a longer follow-up period. These findings agreed with observations that excessive light exposure is associated inversely with MPOD, because clear IOLs transmit higher intensities of blue light than yellow-tinted IOLs.

Combined intravitreal bevacizumab with phacoemulsification in visually significant cataract and visually significant exudative maculopathy

PURPOSE

We investigated the visual outcome of combined phacoemulsification with intravitreal bevacizumab, in eyes with dense cataract and visually significant exudative maculopathy.

MATERIALS AND METHODS

Prospective longitudinal pilot study of consecutive patients treated by two surgeons in 2006, using intravitreal bevacizumab at the end of phacoemulsification. The historical control group consisted of consecutive subjects with exudative maculopathy and dense cataract treated by the same surgeons with the help of phacoemulsification without intravitreal bevacizumab prior to 2006.

RESULTS

Thirty-one treated patients had the mean (SD) logMar best corrected visual acuity improving from - 1.48 (0.50) preoperatively to - 0.67 (0.38) in the first postoperative week (P < 0.001), to - 0.64 (0.40) in the first postoperative month (P < 0.001), and to - 0.62 (0.42) (P < 0.001) on the last follow-up (mean 4.2 months, range 1 - 9 months). Fourteen control patients had the mean (SD) logMar best corrected visual acuity improving from - 1.78 (0.79) preoperatively, to - 0.91 (0.53) in the first postoperative week (P < 0.001), to - 0.86 (0.45) in the first postoperative month (P < 0.001), and to - 0.90 (0.47) (P < 0.001) on the last follow- up (mean 19.6 months, range 1 - 49 months). Initial visual acuities, final visual acuities, and percentage of visual improvement at one month were all not significantly better in the intervention compared to the control group at one month. In the study group, the fovea was flattened at the one-month follow-up, by 90-diopter slit lamp examination and / or Optical coherence tomography.

CONCLUSION

The combination of intravitreal bevacizumab and phacoemulsification is beneficial for maximal visual rehabilitation in the first postoperative month.

A class I (Senofilcon A) soft contact lens prevents UVB-induced ocular effects, including cataract, in the rabbit in vivo

PURPOSE

UVB radiation from sunlight is known to be a risk factor for human cataract. The purpose in this study was to investigate the ability of a class I UV-blocking soft contact lens to protect against UVB-induced effects on the ocular tissues of the rabbit in vivo.

METHODS

Eyes of rabbits were exposed to UVB light for 30 minutes (270-360 nm, peak at 310 nm, 1.7 mW/cm(2) on the cornea). Eyes were irradiated in the presence of either a UV-blocking senofilcon A contact lens, a minimally UV-blocking lotrafilcon A contact lens, or no contact lens at all. Effects on the cornea and lens were evaluated at various times after exposure.

RESULTS

Eyes irradiated with no contact lens protection showed corneal epithelial cell loss plus lens epithelial cell swelling, vacuole formation, and DNA single-strand breaks, as well as lens anterior subcapsular opacification. The senofilcon A lens protected nearly completely against the UVB-induced effects, whereas the lotrafilcon A lens showed no protection.

CONCLUSIONS

The results indicate that use of a senofilcon A contact lens is beneficial in protecting ocular tissues of the rabbit against the harmful effects of UVB light, including photokeratitis and cataract.

Comparison of photochromic, yellow, and clear intraocular lenses in human eyes under photopic and mesopic lighting conditions

PURPOSE

To evaluate the results of the first blue light-filtering photochromic intraocular lens (IOL) and compare them with those of a regular yellow blue light-filtering IOL and a clear ultraviolet-filtering IOL in human eyes under various lighting conditions.

SETTING

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.

DESIGN

Prospective comparative clinical study.

METHODS

This study evaluated eyes that had implantation of 1 of the following 3 IOLs: photochromic Aurium Matrix acrylic, model 400; yellow AF-1 (UY); or clear MC611MI. All eyes were followed for 3 months. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, contrast vision (lighting 400 lux, 30 lux, 5 lux), contrast sensitivity, color vision (Farnsworth-Munsell 100-hue test under 400 lux, 30 lux), and patient questionnaire responses were evaluated.

RESULTS

The photochromic IOL group comprised 39 eyes; the yellow IOL group, 41 eyes; and the clear IOL group, 38 eyes. There were no significant differences between the 3 IOLs in UDVA, CDVA, contrast sensitivity, or questionnaire responses. The photochromic group had significantly better color vision than the yellow IOL group at 30 lux and better contrast vision at 5% contrast (P < .05); however, there were no significant differences between the photochromic IOL group and the clear IOL group (P > .05).

CONCLUSION

The photochromic blue light-filtering IOL performed as well as the yellow and clear IOLs under photopic conditions. Under mesopic conditions, the yellow IOL gave poor color vision and contrast sensitivity.

Effect of the angle of the operating microscope light beam on visual recovery after phacoemulsification: Randomized trial

PURPOSE

To evaluate differences in visual recovery after phacoemulsification with direct or tilted surgical microscope illumination using a macular photostress test.

SETTING

Western Eye Hospital, Imperial College Health Care National Health Service Trust, London, United Kingdom.

METHODS

This randomized double-masked controlled trial enrolled patients presenting to a daycare unit for single-eye cataract surgery. Inclusion criteria were no ocular pathology other than cataract, corneal keratometric astigmatism less than 1.50 diopters, intended target of emmetropia in the operated eye, and cataract grade 1 to 3 (Lens Opacification Classification System II). Exclusion criteria were an abnormal preoperative photostress test. Patients were randomized to have phacoemulsification with the operating microscope angled 15 degrees nasal to the fovea (study group) or with the operating microscope directly overhead around the optic disc region (control group). The same surgeon performed all phacoemulsification procedures using a standardized technique and topical anesthesia. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuity 10 minutes and 60 minutes postoperatively.

RESULTS

In the 30 patients evaluated, the mean UDVA 10 minutes postoperatively was 0.40 logMAR +/- 0.26 (SD) in the study group and 0.72 +/- 0.36 logMAR in the control group (P<.01). The mean CDVA was 0.18 +/- 0.26 logMAR and 0.44 +/- 0.30 logMAR, respectively (P = .016). There was no significant between-group difference in acuity at 60 minutes.

CONCLUSION

Tilting the microscope beam away from the fovea resulted in faster visual recovery and less macular photic stress.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Intraocular lens short wavelength light filtering

There is increasing interest in the effects of reactive oxygen species ('free radicals') in ageing, both in the body overall and specifically in the eye. Cataract and age-related macular degeneration (AMD) are two major causes of blindness, with cataract accounting for 48 per cent of world blindness and AMD accounting for 8.7 per cent. Both cataract and AMD affect an older population (over 50 years of age) and while cataract is largely treatable provided resources are available, AMD is a common cause of untreatable, progressive visual loss. There is evidence that AMD is linked to exposure to short wavelength electromagnetic radiation, which includes ultraviolet, blue and violet wavelengths. The ageing crystalline lens provides some protection to the posterior pole because, as it yellows with age, its spectral absorption increasingly blocks the shorter wavelengths of light. Ultraviolet blocking intraocular lenses (IOLs) have been the standard of care for many years but a more recent trend is to include blue-blocking filters based on theoretical benefits. As these filters absorb part of the visible spectrum, they may affect visual function. This review looks at the risks and the benefits of filtering out short wavelength light in pseudophakic patients.

Prevention of age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula.

Combined cataract extraction and intravitreal bevacizumab in eyes with choroidal neovascularization resulting from age-related macular degeneration

PURPOSE

To evaluate the safety and efficacy of phacoemulsification, intraocular lens (IOL) implantation, and a single intravitreal injection of bevacizumab in patients with coexisting visually significant cataract and subfoveal neovascularization due to age-related macular degeneration.

SETTING

Department of Ophthalmology, University of Bari, Bari, Italy.

METHODS

Eyes with predominantly classic subfoveal neovascularization and cataract had phacoemulsification, IOL implantation, and a 1.25 mg intravitreal injection of bevacizumab. One month after combined surgery, corrected distance visual acuity (CDVA), anterior chamber reaction, and intraocular pressure were evaluated and central foveal thickness was measured by optical coherence tomography.

RESULTS

Twenty eyes of 20 patients were evaluated. One month postoperatively, the mean CDVA improved significantly, from 20/100 (range 20/160 to 20/80) at baseline to 20/63 (range 20/125 to 20/50) (P<.0001). The mean central foveal thickness decreased significantly, from 353.75 microm +/- 12.50 (SD) (range 334 to 375 microm) at baseline to 275.7 +/- 17.3 microm (range 255 to 323 microm) at 1 month (P<.0001). Intraocular pressure did not change significantly, and anterior chamber reaction was absent. No ocular or systemic adverse events were observed.

CONCLUSION

Combined phacoemulsification, IOL implantation, and intravitreal bevacizumab was a safe and efficacious treatment in patients with visually significant cataract and active subfoveal neovascularization.

Cataract surgery in high-risk age-related macular degeneration: a randomized controlled trial

BACKGROUND

To investigate if cataract surgery causes progression, from high-risk early age-related macular degeneration (AMD) to choroidal neovascularization (CNV), in the postoperative period.

METHODS

Randomized controlled trial. Patients, with visually significant cataract and fundus features of early AMD at high risk of progression to CNV, were randomized into two groups and were evaluated at baseline and 6 months. The study patients (n = 27) underwent immediate cataract surgery. The control group (n = 29) comprised patients who had cataract surgery deferred until after the 6-month visit. Assessment included visual acuity, quality of life (QoL) and fundus fluorescein angiography (FFA).

RESULTS

Of 68 eligible eyes, 60 participated and 56 completed the study. Three referred eyes (3.2%) were ineligible on the basis of a pre-existing, unsuspected occult CNV that was detected by baseline FFA. All three cases had end-stage exudative AMD in the fellow eye. Of the study eyes in the immediate surgery arm (n = 27), one (3.7%) developed CNV compared with none (0/29) in the deferred arm (chi(2); P = 1.0) at 6 months. In the operated group, there was a 2.8-line improvement in logMAR visual acuity and 2.1-fold average gain in QoL at 6 months.

CONCLUSIONS

No increased short-term risk of progression of AMD to CNV in high-risk fundi following uncomplicated phacoemulsification surgery was found. A low threshold for performing preoperative imaging in patients with AMD, especially in those with exudative AMD in the fellow eye, to exclude undetected CNV is recommended. Provided there is no CNV, there are distinct benefits of cataract surgery in people with early AMD.