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Prior Cataract Surgery Affects Success Rate of Antiangiogenic Therapies in Treating Wet Macular Degeneration: Presented at RC2009

By Cameron Johnston

NEW YORK -- October 5, 2009 -- Patients who have choroidal neovascularisation secondary to age-related macular degeneration (AMD) and are treated with either ranibizumab, bevacizumab, or pegaptanib do not respond as well to treatment if they have had prior cataract surgery, researchers reported here at the Retina Congress (RC) 2009.

Ayala Pollack MD, Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel, presented the findings of a retrospective chart review on October 2.

Dr. Pollack and colleagues reviewed the cases of 24 phakic and 19 pseudophakic eyes of patients who had been newly diagnosed with exudative AMD and were treated with antiangiogenic intravitreal injections.

The patients were followed from the time of their first treatment for an average of 16 months if they had not had cataract surgery and for a mean of 19 months if they had had cataract surgery. Patients received a mean of 6.5 injections and 5.6 injections in the 2 groups, respectively.

Patients who had surgery for their cataracts or who received other forms of treatment for their AMD during the follow-up period were excluded from the study.

The analysis found that patients who had not had prior cataract surgery fared slightly better than those who had had their cataracts removed and had intraocular lenses implanted.

The mean improvement in best corrected visual acuity (VA) was 4 ETDRS letters for phakic patients, compared with a loss of 4 letters for pseudophakic patients. Seven patients developed AMD within 2 years of having their cataract surgery and for those patients, the loss in VA was even greater -- a mean of 10 ETDRS letters.

Dr. Pollack said further prospective studies are needed to confirm these results. When initiating patients on antiangiogenic therapy, consideration should be given to whether these patients have intact lenses. A more aggressive therapeutic regimen may be warranted if patients have had cataract surgery, and in particular, if they had their surgery within the 2 years immediately preceding the diagnosis of wet AMD.

The 2009 Retina Congress is a combined meeting of the American Society of Retina Specialists, the Macula Society, and the Retina Society.

[Presentation title: Response to Anti-Angiogenic Treatment in Age-Related Macular Degeneration: A Comparison of Phakic and Pseudophakic Eyes. Poster 755]

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