ABSTRACT

Purpose:

To evaluate the visual and anatomic outcomes of patients who underwent phacoemulsification combined with intravitreal ranibizumab (IVR) injection in neovascular age related macular degeneration (nAMD).

Setting:

Department of opthalmology, Mugla Sitki Kocman University Faculty of Medicine

Methods:

The first year visual and anatomic outcomes of 50 eyes of 50 nAMD patients were determined. Group 1 consisted of 19 eyes of 19 patients who received first IVR with phacoemulsification due to presence of significant cataract and continued pro re nata (PRN) regimen after 2 monthly injections. Group 2 consisted of 31 eyes of 31 phakic patients (without cataract) who received PRN regimen after 3 monthly injections. Pre and postoperative best corrected visual acuities (BCVAs), number of IVR injections and anatomic outcomes such as central foveal thicknesses (CFTs) and presence or abscence of subretinal fluid (SRF) or intraretinal cysts were also determined with optical coherence tomography.

Results:

All patients in group 1underwent uneventful cataract surgery combined with 0.5mg/0.5mL IVR injection. Mean BCVA significantly improved from 0.9±0.33 logMAR to 0.4±0.35 logMAR in group 1 and 0.77±0.4 logMAR to 0.52±0.36 logMAR in group 2 (p<0.001). BCVA increase was significantly higher in group 1 (0.34± 0.19 logMAR) than group 2 (0.18±0.15 logMAR) (p=0.003). Mean number of IVR injections during one year was 6.2±1.8 (range 3-9) in group 1 and 6±2 in group 2 (range 3-9) (p=0.374). Mean CFT significantly decreased from 311±159µ to 241±119µ (p<0.001) in group 1 and 360±135µ to 242±84µ in group 2 (p<0.001). CFT decrease was insignificant between two groups (69±49µ in group 1 and 115±112µ in group 2, p=0,535). 17 (89.5%) eyes in group 1 and 27 (87.1%) eyes in group 2 had SRF before IVR injections (p=0.802). There was no worsening of SRF, however 3 (15.8%) patients in group 1 and 3 (9.7%) patients in group 2 (p=0.519) had still SRF at the end of one year. IRCs w ere present in 2 patients (10.5%) in group 1 and 2 (6.5%) patients (p=0.606).

Conclusion:

Ranibizumab is effective in reducing the subretinal exudations related to active subfoveal neovascularization despite potential inflammatory effect of cataract surgery. Anatomic outcomes suggest that cataract surgery does not appear to worsen nAMD , conversely safe and have favourable visual outcomes in patients with nAMD.


CONTACT DETAILS

 

Sabahattin SÜL, Aylin KARALEZLI*, Mujdat KARABULUT
Mugla Sitki Kocman Universitesi Tip Fakultesi
MuÄŸla
Turkey
Email : drsulgoz@gmail.com
Cell Phone: +902522144804
Work Phone: +902522144804