Cataract surgery and age-related macular degeneration. An evidence-based update

Line Kessel, Ditte Erngaard, Per Flesner, Jens Andresen, Britta Tendal, Jesper Hjortdal, Line Kessel, Ditte Erngaard, Per Flesner, Jens Andresen, Britta Tendal, Jesper Hjortdal

Abstract

Purpose: Age-related macular degeneration (AMD) and cataract often coexist in patients and concerns that cataract surgery is associated with an increased risk of incidence or progression of existing AMD has been raised. This systematic review and meta-analysis is focused on presenting the evidence concerning progression of AMD in patients undergoing cataract surgery.

Methods: We performed a systematic literature search in the PubMed, Medline, Cochrane Library and CINAHL databases. Two randomized trials and two case-control trials were identified. Quality of the studies was assessed using the Cochrane risk of bias tool, data were extracted, and meta-analyses were performed. Quality of the available evidence was evaluated using the GRADE system.

Results: We found that visual acuity at 6-12 months follow-up was significantly better (6.5-7.5 letters) in eyes that had undergone cataract surgery than in unoperated eyes, but the included number of subjects was small, and hence, the quality of evidence was downgraded to moderate. We did not find an increased risk of progression to exudative AMD 6-12 months after cataract surgery [RR 3.21 (0.14-75.68)], but the included number of subjects was small, and thus, the quality of the evidence was moderate.

Conclusion: Cataract surgery increases visual acuity without an increased risk of progression to exudative AMD, but further research with longer follow-up is encouraged.

Keywords: age-related macular degeneration; cataract surgery; exudative age-related macular degeneration; outcome; visual acuity.

© 2015 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Figures

Figure 1
Figure 1
Forest plot comparing visual acuity (logMAR) at 6 months (Hooper et al. 2009) or 12 months (Armbrecht et al. 2003 and Baatz et al. 2008) after cataract surgery or observation. SD = standard deviation, IV = inverse variance, CI = confidence interval.
Figure 2
Figure 2
Forest plot showing progression to exudative AMD during a 6 (Hooper et al. 2009) to 12 months follow‐up period (Armbrecht et al. 2003; Baatz et al. 2008 and Brunner et al. 2013) in eyes with AMD undergoing cataract surgery or being observed without surgery. M‐H = Mantel‐Haenszel, CI = confidence interval.

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