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Should having cataract surgery affect follow-up appointments in patients with wet AMD?

Free Paper Details

First Author: K.Aggarwal UK

Co Author(s):    A. Ding-Wu   M. Bindra   M. Groppe              

Abstract Details

Purpose:

The overall prevalence of late AMD is estimated at 2.4%. The number of people with late AMD in the UK will rise by a third to 679,000 between 2010 and 2020. In addition to this increasing demand, 400,000 cataracts are performed per year in the UK and demand for surgery is predicted to rise by 25% over the next 10 years. It is possible that cataract surgery may re-activate wet AMD. The Royal College of ophthalmologists guidelines suggest that patients with suspected wet AMD should be seen within 2 weeks. However this increasing demand cannot be met by clinic capacity.

Setting:

Ophthalmology department in district general hospital in UK

Methods:

We examined all patients who underwent cataract surgery and were receiving intravitreal anti–vascular endothelial growth factor injections (IVI) from 01/12/17- 30/11/18 as a retrospective cohort study. 4133 cataract operations and 6149 injections for AMD performed at Amersham/Stoke Mandeville between 01/12/17-30/11/18, notes from pharmacy. 106 patients received injections for wet AMD at any time, either preceeding or after cataract surgery. Data collected included the development of subretinal or intraretinal macular fluid; number of injections; best-corrected visual acuity (BCVA); and central retinal thickness (CRT).

Results:

Cataract surgery does improve mean BCVA in wet AMD patients by -0.13 (-0.88 to + 0.44) and does not change CRT pre and post surgery (p=0.79). 7.5% (8/106) patients developed wet AMD following cataract surgery having never previously received IVI pre-operatively with the mean time to activation was 75.38 days (range 31-183). The BCVA presentation of reactivation was 0.40 compared to VA pre-operatively of 0.47. 17% (18/106) did not reactivate after at least 12 month follow up following cataract surgery. 71.7% required more IVI post operatively with a pre-operative injection interval average is 7.15 weeks and post-operative of 6.7 weeks.

Conclusions:

Patients who are undergoing cataract surgery should have follow up done at 4 weeks either by the AMD service or post operative clinic. In this cohort, pre-operative dry AMD patients who do reactivate are appropriately treated within 14 days +/- FFA according to the Royal College of Ophthalmologists guidelines for wet AMD. Telephone and virtual follow up may affect this in the future.

Financial Disclosure: