The relation of phacoemulsification and progression of age-related macular degeneration

Background. It is currently impossible to draw definitive conclusions whether phacoemulsification (PhE) is safe for people with age-related macular degeneration (ARMD). It is not clear if PhE causes the progression of ARMD and affects visual acuity (VA). The purpose was to analyze the possible association of PhE with ARMD progression in the early and late (up to 18 months after surgery) period. Materials and methods. The study included 86 patients (93 eyes), 37 men and 49 women aged 60 to 82 years, who were operated for PhE (implantation of soft intraocular lens on the camera Infiniti, “Alcon”, USA). ARMD was assessed based on the classification of the American Academy of Ophthalmologists (AREDS, 2001). Patients were examined 1, 3, 6, 12 and 18 months after surgery. For statistical processing of obtained data, Statistica 10 (StatSoft, Inc., USA) and MedCalc Statistical Software 18 (MedCalc Software bvba, Belgium) were used. Results. In 69.9 % of eyes with cataract, ARMD was registered: early and midstage (AREDS 2 and 3) was diagnosed in 16.1 % of cases, late stage (AREDS 4.1) — in 25.8 %, and exudative (AREDS 4.2) — in 28.0 %. VA before surgery was consistent with the stage of ARMD and was worse in AREDS 4. To evaluate the progression of ARMD, the index of progression (IP) was developed characterizing the average rate of ARMD clinical manifestations change. The progression of ARMD within 18 months (IP > 0) after the PhE was observed in 33.3 % of cases, including 12.9 % of first determined ARMD. Patients without ARMD progression were 6 years younger than those that had progression (p = 0.001). When IP = 0.100, the disorder progressed at the early stages (3 months); when IP = 0.033, in the later period (12 and 18 months). After surgery, VA was significantly increased, which depended on the initial stage of ARMD (VA was worse at the late stage and in AREDS 4) and ARMD progression (VA was worse when IP > 0, and in the cases of progression when IP = 0.033, that is, with the later ARMD progression). Conclusions. The characteristics of the stages of ARMD and VA dynamics after PhE suggest a positive impact of PhE on the ARMDS progression.