Eyeworld

113 EW INTERNATIONAL March 2017 related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2014;252:1573–9. Editors' note: Dr. Vassileva has no financial interests related to her com- ments. Contact information Vassileva: centersight@sobalpashev.com hard to define the cause for vision loss. Our decision to perform cata- ract surgery in our wet AMD patients is really a personalized timing ap- proach. We have to perform surgery when visual acuity decreases but must take into consideration all the risk factors and make sure to always explain the process to patients along the way. Cataract surgery is benefi- cial for all patients who have the co- morbidities wet AMD and cataract. Surgery provides them with a better quality of life and should not be de- layed to ensure optimal monitoring and treatment of wet AMD. Patients with wet AMD should receive blue light filtering IOLs, and they need to be followed very closely after phacoemulsification, especially macula monitoring using OCT and fluorescein angiography to identify fluid recurrence." EW Reference 1. Lee G, et al. Factors influencing the exu- dation recurrence after cataract surgery in patients previously treated with anti-vascular endothelial growth factor for exudative age– intraretinal cysts had a higher prev- alence in Group I. The risk factors were the existence of a dry macula period before surgery, the number of intravitreal injections, and wet AMD severity. The patients with fluid recurrence had fewer anti-VEGF injections before phacoemulsifi- cation surgery. They had a shorter dry macula period before and after phaco and needed more injections after surgery for visual recovery," Dr. Vasilleva explained. Fluorescein angiography re- vealed a predominance of classic choroidal neovascularization in Group IA (66.6%) and a predomi- nance of occult choroidal neovas- cularization in Group IB. Group II demonstrated a predominance of classic choroidal neovascularization (63.5%). Dr. Vasilleva observed better BCVA outcomes in patients who were treated for wet AMD prior to cataract surgery and who experi- enced longer dry macula periods both before and after surgery. The patients from Group IB and Group II needed a longer time to improve BCVA. Dr. Vasilleva's observations concur with previous studies that demonstrated risk factors associated with exudation recurrence in wet AMD patients undergoing cataract surgery. One such study was a retro- spective review of medical records of which 39 patients were identified as having had cataract surgery after being treated with anti-VEGF drugs for exudative AMD. 1 It showed that the diagnosis to surgery period (P = 0.001) and the preoperative exu- dation-free period (P < 0.001) were both significantly longer in patients without recurrence than in patients with recurrence. The study authors recommended that cataract surgery be performed after a sufficiently long exudation-free period to minimize exudation recurrence. Performing cataract surgery at the right time for each patient is of the essence. Dr. Vasilleva noted, "Many studies show evidence of increased risk associated with cata- ract surgery for AMD progression, especially in patients with wet AMD. But, when patients have both wet AMD and cataract and visual acuity is declined, monitoring macular changes is more difficult, and it is " Our decision to perform cataract surgery in our wet AMD patients is really a personalized timing approach. We have to perform surgery when visual acuity decreases but must take into consideration all the risk factors and make sure to always explain the process to patients along the way. " —Petya Vasilleva, MD

• Blank Page
• Blank Page (1)