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Cataract Surgery May Not Exacerbate Exudative Age-related Macular Degeneration: Presented at ARVO

By Earl R. Nichols

FT. LAUDERDALE, FL -- May 5, 2005 -- The preliminary results of a European study suggest that cataract surgery may be safe for patients with confirmed dry age-related macular degeneration (AMD), resulting in improved visual function without AMD progression.

The findings are important given that macular degeneration and cataracts are both common in older individuals. For years, researchers have theorized that cataract surgery might exacerbate AMD or cause the disease to progress faster.

According to Simon Brunner, MD, professor of ophthalmology, Rudolph Foundation Hospital, Vienna, Austria, one of the problems with performing cataract surgery on patients with presumed macular degeneration is that fluorescein angiography (FA) is not used routinely, making it difficult to determine with certainty whether the patient's MD was exudative or dry, classic or occult.

At the Association for Research in Vision and Ophthalmology Annual Meeting here May 3^rd, Dr. Brunner presented findings from 30 patients who completed an ongoing study. Researchers are measuring parameters such as visual acuity, contrast sensitivity, cataract staging, visual function and FA. The main endpoint is progression of AMD over 6 months.

The European study will eventually enroll 320 patients into an early surgery group or a control group

While macular drusen were observed in all patients and atrophy of the pigmented epithelium was seen in 57% to 62%, the composition of the AMD did not change over the 6-month post-surgery period.

Functional test results were positive in most patients, with 17 patients in the early-surgery group recording an average increase in distance acuity from 0.26 to 0.33 on the Snellen chart after 6 months.

There was virtually no difference in distance acuity in the control group (n=13) where the Snellen scores increased from 0.22 to 0.27. There was a similar small but important increase in subjective visual function, with the VF-14-questionnaire showing an average increase from 2.72 to 2.92 points in the study group and from 2.43 to 3.04 points in the control group. FA did not reveal any growth or shrinkage in size of AMD lesions.

These findings compare with two previously published retrospective studies in which cataract surgery was seen to exacerbate early AMD and one study which showed that surgery almost doubled the risk of exudative AMD progressing, Dr. Brunner said.

The results of this small ongoing study seem to suggest that cataract surgery does not exacerbate exudative AMD, and that there may not be any reason to postpone surgery in these patients, he said. Surgery was postponed, however in those patients whose AMD was seen to be leaking on FA, even if this leakage was asymptomatic. Dr. Brunner recommended that FA be mandatory to detect those cases before surgery is considered.

The study will continue in Vienna and four other European centres for another 4 years.


[Presentation title: Cataract Surgery in Nonexudative Age-Related Macular -First Results of a Prospective, Randomized, Multicenter Trial (ECAM-1). Poster 195/B169]

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