Cataract Surgery May Accelerate Wet AMD in Certain Patients

Cataract surgery may worsen neovascular activity in certain patients by triggering inflammation that disrupts the blood-aqueous barrier and allows cytokines to enter the posterior segment. These inflammatory proteins can remain in the eye after surgery and cause angiogenic and exudative changes. Photo: National Eye Institute. Click image to enlarge. Age-related eye conditions such as cataracts and macular degeneration often coexist, making it increasingly important to understand how to manage these two diseases in concert. In fact, several studies have suggested that cataract surgery may accelerate wet AMD progression. Korean researchers assessed the impact of phacoemulsification on wet AMD, using injection interval as a way of evaluating clinical AMD activity. They also looked at whether choroidal biomarkers and macular neovascularization (MNV) subtypes predicted a need for more postop treatment requirements. Their findings, published recently in Retina, are described below.The retrospective study included 84 eyes of 84 patients with wet AMD who underwent cataract surgery while also undergoing anti-VEGF therapy. The researchers defined increased treatment need as a shortened injection interval or occurrence of submacular hemorrhage.They reported that patients’ BCVA remained stable after surgery, showing no major differences among MNV subtypes. Choroidal vascularity index and subfoveal choroidal thickness both increased significantly after cataract surgery.About 45% of eyes had an increased treatment need during the study, and these same eyes also showed markedly higher preop and postop choroidal vascularity index. Eyes with the polypoidal choroidal vasculopathy subtype had the highest rates of increased treatment need and the shortest injection intervals. The researchers observed that higher preop choroidal vascularity index was independently associated with higher treatment needs in the postop period.Given these findings, the researchers concluded that cataract surgery is linked to “measurable changes” in the choroid in wet AMD patients. “Although cataract surgery can be performed safely in this population, these changes appeared more pronounced in certain subgroups,” the researchers wrote in their paper. “Our findings highlight the potential value of preoperative risk stratification based on MNV subtype and choroidal characteristics.”Click here for the journal source. Cha E, Youn J, Yun C, et al. Impact of phacoemulsification on neovascular age-related macular degeneration activity: predictive role of choroidal vascularity and MNV subtypes. Retina. April 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.