Effects of cataract surgery on eyes with neovascular age-related macular degeneration undergoing anti-vascular endothelial growth factor therapy under a treat-and-extend regimen.

purposeTo evaluate the effects of cataract surgery on eyes with neovascular age-related macular degeneration (nAMD) undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy under a treat-and-extend (TAE) regimen.

methodsThis retrospective observational study included eyes with nAMD receiving anti-VEGF therapy under a TAE regimen and undergoing cataract surgery, with anti-VEGF therapy continued for ≥ 6 months before and after surgery. Best-corrected visual acuity (BCVA), retinal exudation, central retinal thickness (CRT), and subfoveal choroidal thickness (SFCT) were evaluated at the preoperative baseline and at 1 and 6 months after surgery. Anti-VEGF treatment intervals at the preoperative baseline and at 6 months after surgery were compared, and the number of injections during the 6 months before and after surgery was assessed. Factors associated with treatment-interval shortening at 6 months were analyzed using multivariate logistic regression.

resultsA total of 85 eyes from 82 patients were included. Median BCVA significantly improved from 0.52 logMAR at baseline to 0.10 at 1 month and 0.05 at 6 months (P < 0.001 for both). At 6 months, 53 eyes (62.4%) showed improved BCVA and 32 eyes (37.6%) remained stable; no eyes demonstrated visual deterioration. The proportion of eyes with retinal exudation was 21.2% at baseline, 29.4% at 1 month, and 32.9% at 6 months, with no significant differences. CRT increased significantly at 6 months compared with baseline (P = 0.004), and SFCT increased significantly at both 1 and 6 months compared with baseline (P < 0.001 for both). Although neither the median anti-VEGF treatment interval nor the median number of injections significantly changed before and after surgery, individually, 31.8% of eyes required shorter treatment intervals and 42.4% achieved longer treatment intervals at 6 months. Greater CRT at the preoperative baseline was a significant factor associated with treatment-interval shortening.

conclusionsCataract surgery in eyes with nAMD receiving anti-VEGF therapy under a TAE regimen appears beneficial for maintaining or improving visual acuity at 6 months despite the presence of postoperative retinal and choroidal anatomical changes. Changes in anti-VEGF treatment intervals varied among individuals, and greater preoperative CRT may serve as a useful indicator for predicting treatment-interval shortening. KEY MESSAGES: WHAT IS KNOWN : Cataract surgery in eyes with neovascular age-related macular degeneration (nAMD) treated under pro re nata (PRN) or mixedregimens has been associated with significant improvements in mean or median visual acuity; however, some individual eyes haveshown postoperative visual deterioration. The effects of cataract surgery on retinal and choroidal morphology and disease activity in nAMD remain controversial. WHAT IS NEW: In eyes with nAMD undergoing continuous anti-vascular endothelial growth factor (anti-VEGF) therapy under a treat-and-extend(TAE) regimen, cataract surgery significantly improved median visual acuity at 6 months, with no eyes showing postoperativevisual deterioration. Although central retinal thickness (CRT) and subfoveal choroidal thickness increased after surgery, these anatomical changes didnot lead to visual functional decline under continued TAE management. Changes in anti-VEGF treatment intervals varied among individuals, and greater preoperative CRT was associated with the needfor treatment-interval shortening at 6 months after cataract surgery.