[Analysis of the effectiveness of cataract surgery in neovascular age-related macular degeneration].

Abstract

Purpose: This study evaluated the impact of phacoemulsification cataract surgery (PE) on anatomical and functional parameters, as well as the regimen and frequency of anti-VEGF injections in patients with neovascular age-related macular degeneration (nAMD) over a long-term period (up to 3 years).

Material and methods: The study included 117 patients (117 eyes) diagnosed with nAMD and cataract, graded by LOCS: LOCS I (n=56; 47.9%), LOCS II (n=57; 48.7%), LOCS III (n=4; 3.4%); the average age of the patients was 76.2±5.7 years. All patients received anti-VEGF therapy (aflibercept 2 mg) following the treat-and-extend protocol. PE was performed only with disease activity under control. The observation period included 12 months before PE and 36 months after, with eight checkpoints for standard ophthalmological examination.

Results: The average number of injections before PE was 6.85±1.78. In the first year after PE, the injection frequency increased to 7.85±0.83, then decreased to 7.04±1.50 in the second year and 3.85±1.22 in the third, with intervals between injections lengthening (to 13.35±1.84 weeks by the third year). All eyes (100%) demonstrated significant improvement in best-corrected visual acuity (BCVA), with an absolute increase of 0.28 from pre-PE baseline (from 0.22±0.17 to 0.50±0.18 by study end). There was a positive trend in reduction of central retinal thickness (by 138.5 μm or 36.5%) compared to baseline at the start of treatment, as well as reduction in neuroretinal and retinal pigment epithelial detachment over the observation period. Statistically significant correlations were found between BCVA, injection frequency, injection interval, and morphological biomarkers of nAMD activity over time.

Conclusion: Initiation of antiangiogenic therapy in nAMD patients and the continuation of individualized monitoring and treatment after PE is associated with effective suppression of nAMD activity, improvement in functional and anatomical parameters, and a reduction in the number of intravitreal injections both in the short term and the long term.