Comprehensive evaluation of cataract phacoemulsification surgery efficacy in patients with neovascular age-related macular degeneration treated by of antiangiogenic drugs

   The aim of the study is a comprehensive assessment (including the patient’s opinion) of the impact of cataract phacoemulsification on the state of visual functions, morphological biomarkers of disease activity in patients with neovascular age-related macular degeneration (nAMD) against the background of antiangiogenic therapy.

   Material and methods. The study included individuals with nAMD and cataract; the main group included 117 patients (117 eyes) (age 76.2 ± 5.7 years, arithmetic mean ± standard deviation), and the control group included 96 people (96 eyes) (age 77,01 ± 6,02 years). All patients received angiogenesis inhibitor therapy (aflibercept 2 mg), in Treat&Extend regimen, patients in control group – after phacoemulsification. In the main group, phacoemulsification was performed under the condition of monitoring disease activity. A questionnaire including 10 questions was developed to interview patients, 9 of which were assessed before, 1 and 6 months after phacoemulsification, and a 10th question on patient satisfaction with the results of surgery – 1 and 6 months after cataract surgery.

   Results. The number of injections was 6.85 ± 1.78 before surgery, 7.85 ± 0.83 in the first year with a subsequent decrease to 7.04 ± 1.50 and 3.85 ± 1.22 in the second and third years, respectively; the interval between injection was prolonged accordingly (to 13.35 ± 1.84 weeks by the third year). In 100 % of eyes, there was a significant improvement in best-corrected visual acuity with an absolute increase from pre-surgery baseline to the end of follow-up by 0.28 (from 0.22 ± 0.17 to 0.50 ± 0.18). Positive dynamics of the central retinal thickness reduction (by 138.5 μm, 36.5 %) was noted in comparison with value at the beginning of therapy, as well as neuro- and pigment epithelium detachment throughout the entire observation period. Statistically significant correlations of best-corrected visual acuity, number of injections, and interval between injections with morphologic biomarkers of nAMD activity were found throughout the follow-up. There was a significant improvement in patients’ assessment of vision-related quality of life. The most compromised aspect before surgery was the ability to read text in newspapers, books, and magazines. After surgery there was a significant improvement of the indicators characterizing the patient’s adaptation to navigation and outside activities. 99 patients (84.0 %) reported satisfaction with the results of the surgery.

   Conclusions. Cataract surgery and continuation of antiangiogenic therapy of nAMD based on MNV activity are accompanied by a reduction in the number of intravitreal injections and contribute to the positive dynamics of functional and anatomical parameters in the short and long term, which is of clinical value to the physician and has an important impact on the daily functioning of the patient.

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