Effect of Phacoemulsification on Visual Acuity and Macular Morphology in Patients with Wet Age-Related Macular Degeneration.

BACKGROUND This article discusses the effectiveness of phacoemulsification cataract surgery with intraocular lens implantation in patients with wet age-related macular degeneration in the inactive phase of the disease. MATERIAL AND METHODS Forty-nine patients (50 eyes) aged 78.94±5.54 years, previously treated with intravitreal injections of anti-vascular endothelial growth factor agents, were qualified for a prospective, randomized 12-month study. The participants were divided into 2 groups. Group I consisted of 25 patients (25 eyes) who were subjected to phacoemulsification cataract surgery. Group II consisted of 24 patients (25 eyes) who were not subjected to phacoemulsification cataract surgery despite having a lens opacity of grade II or higher according to the Lens Opacities Classification System. RESULTS After 12 months of follow-up, patients in group I gained on average 8.04 letters (p<0.001). Furthermore, 20% of the eyes had a significant improvement in best corrected visual acuity of ≥15 Early Treatment of Diabetic Retinopathy Study Chart letters. Patients in group II lost on average 1.96 letters (p>0.05). No significant differences between central retinal thickness values in either group (p>0.05) were noted. The mean number of intravitreal injections of anti-vascular endothelial growth factor agents during the study was 2.64±1.98 in group I and 2.92±2.40 in group II (p>0.05). CONCLUSIONS Phacoemulsification performed in eyes with wet age-related macular degeneration during the inactive phase of the disease significantly improves visual acuity. In addition, it does not significantly influence the frequency of intravitreal injections of anti-vascular endothelial growth factor agents or disease activity.

[Combined pharmacological-surgical treatment in exudative age-related macular degeneration]. / Terapia laczona chirurgiczno-farmakologiczna wysiekowej postaci zwyrodnienia plamki zawiazanego z wiekiem.

PURPOSE: The aim of this paper is to present the early phase of treating exudative age-releted macular degeneration (AMD)--coexisting witch vitreoretinal pathology--with combined pharmacological-surgical therapy. MATERIAL AND METHODS: Our observation is based on one clinical case of combined therapy: pars planavitrectomy (PPV) and one intravitrealranibizumab injection. Observation is being carried on larger patient group according to the treatment scheme presented In this paper. RESULTS: In this case described combined pharmacological-surgical therapy allowed a significant improvement in visual acuity and closure of choroidal neovascularization (CNV), leakage confirmed by fluorescein angiography (FA) and optical coherence tomography (AMD). The treatment is being continued--another ranibizumab injection according to PRONTO study reinjection criteria. CONCLUSIONS: The pathomechanism of exudative AMD and coexistance of vitreoretinal pathology implications confirm reasonability of combined therapy.Due to actual clinical studies: the pharmacological -surgical treatment reduces the number of required intravitreal anti-VEGF agents injections. To confirm this observation we need to perform large randomised clinical studies.