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| |  Cataract Surgery Does Not Pose Risk in Patients Receiving Anti-VEGF Therapies for Age-Related Macular Degeneration: Presented at ARVO By Cameron Johnston FORT LAUDERDALE, Fla -- May 4, 2009 -- Cataract surgery among patients with age-related macular degeneration (AMD) who are being treated with either bevacizumab or ranibizumab does not lead to an increase in the rate of progression from the dry to the wet form of the disease, according to a large retrospective trial presented here on May 3 at the Association for Research in Vision and Ophthalmology (ARVO) 2009 Annual Meeting. In addition, the procedure does not appear to have any impact on the patient's visual acuity or subretinal fluid formation. According to Namrata Kapoor MD, Bascom Palmer Eye Institute and the University of Miami, Miami, Florida, doctors have been reluctant to perform cataract surgery on patients with AMD, because it was believed that in some patients the surgery led to the development of cystoid macular oedema. Also, cataract surgery and the choroidal neovascularisation in macular degeneration are both associated with inflammation. Therefore, it was felt that this could create a catastrophic inflammatory response in the retina. Dr. Kapoor and colleagues investigated whether cataract surgery is safe and effective for patients with AMD undergoing anti-vascular endothelial growth factor (VEGF) therapy. They evaluated 63 eyes of 62 patients who had wet AMD and underwent cataract surgery. All patients all had active choroidal neovascularisation and had received at least 1 injection of an anti-VEGF drug in the month preceding their cataract surgery. They were followed for an additional 3 months. They were evaluated for changes in fluid build-up as seen on optical coherence tomography (OCT), changes in visual acuity, and the number of injections they required in the follow-up period. There was no change in the percentage of patients who had subretinal fluid as seen on OCT, although Dr. Kapoor pointed out that data concerning central retinal thickness were not gathered or analysed in this study. The data merely showed that roughly the same number of patients had at least some fluid present on OCT at baseline as had fluid after 3 months of follow-up. Ultimately, Dr. Kapoor said this still does not entirely answer the question of whether cataract surgery exacerbates or complicates the progression of AMD. This study only looked at whether there was a clinical or functional change after the surgery in patients who had established AMD and were being treated with anti-VEGF drugs. In that respect, she said, these results have already produced some changes in clinical practice. In this study, for example, approximately half of the patients had an anti-VEGF injection within the month preceding cataract surgery. At Bascom Palmer, anti-VEGF injections are now given up to 1 week prior to the surgery, and increasingly, cataract surgeons are recognising that this procedure is not a significant risk factor for complicating or exacerbating the progression of macular degeneration. Funding for this study was provided by Genentech, Inc. [Presentation title: Cataract Surgery in Patients Receiving Intravitreal Bevacizumab or Ranibizumab for Neovascular AMD. Abstract 237]
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