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.
Hooper
Claire Y
CY
Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia.
Lamoureux
Ecosse L
EL
Lim
Lyndell
L
Fraser-Bell
Samantha
S
Yeoh
Jonathan
J
Harper
Colin A
CA
Keeffe
Jill E
JE
Guymer
Robyn H
RH
D000368:Aged; D000369:Aged, 80 and over; D020256:Choroidal Neovascularization / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D019654:Lens Implantation, Intraocular; D008268:Macular Degeneration / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects*; D010865:Pilot Projects; D011788:Quality of Life; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*