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Outcome of Cataract Surgery in Patients with Geographic Atrophy Secondary to AMD

Miller D., Jorzik J., Schmitz-Valckenberg S., Herrmann M., Holz F. G.,
Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)

Purpose: There is little information on outcome of cataract surgery in presence of retinal ocular comorbidity such as advanced age-related macular degeneration (AMD). We sought to assess subjective and objective visual changes after cataract extraction in patients with geographic atrophy (GA) secondary to AMD.
Method: A retrospective analysis for overall satisfaction, subjective visual change, and visual acuity changes pre- and postoperatively was undertaken in a consecutive series of 32 eyes from 21 patients with GA undergoing cataract surgery for relatively minor lens opacities.
Results: Mean age at surgery was 77.8 years (range 68-91 years). 23 (72%) and 9 (28%) of cataract surgeries, before foveal subgroup analysis, were reported as being worthwhile or not worthwhile, respectively, with corresponding foveal values of 9 (69%) and 4 (31%) and non-foveal values of 14 (74%) and 5 (26%). Subjective visual function was reported to be improved, worsened, or unchanged in 21 (66%), 4 (13%), and 7 (21%) of cases before subgroup analysis, with corresponding values of 5 (39%), 2 (15%), and 6 (46%) for foveal involvement and 14 (74%), 1 (5%), and 4 (21%) for non-foveal involvement. Visual acuity changes showed >1 line improvement in 11 (34%), >1 line worsening in 4 (13%), and were ±1 line in 17 (53%) of all eyes before subgroup analysis, with corresponding values of 3 (23%), 2 (15%), and 8 (62%) for foveal involvement, and 8 (42%), 2 (11%), and 9 (47%) for non-foveal involvement. Average visual acuity values were 0.23 (SD 0.16) preoperatively and 0.26 (SD 0.20) postoperatively before subgroup analysis, with values of 0.22 (SD 0.15) and 0.25 (SD 0.20) for foveal involvement and of 0.26 (SD 0.16) and 0.27 (SD 0.19) for non foveal involvement.
Conclusions: Cataract surgery in patients with GA secondary to AMD provided overall subjective improvement in a majority of cases. Visual function, although limited due to retinal pathology, was also found to improve overall, with a notable difference in improvement between non-foveal and foveal cases. Subjective improvement may be noted despite unchanged visual acuity in presence of eccentric fixation. These data are helpful for patient education prior to surgery with regard to subjective and functional outcome.