[Antiangiogenic therapy after cataract surgery in neovascular age-related macular degeneration (clinical...

The combination of age-related cataract and neovascular age-related macular degeneration (nAMD) presents a clinically challenging scenario, as it requires continuation of anti-angiogenic therapy during the perioperative period. The impact of cataract phacoemulsification (PE) on nAMD activity and the need for continued anti-VEGF treatment remains a subject of debate.

This study assessed the safety profile and progression of nAMD over 12 months following phacoemulsification in patients undergoing treatment with aflibercept and brolucizumab.

This retrospective-prospective study included 24 patients (24 eyes) with nAMD and age-related cataract. Two groups were formed: the brolucizumab group (n=12) and the aflibercept group (n=12). All patients underwent PE with intraocular lens (IOL) implantation. The examination protocol included best-corrected visual acuity (BCVA) assessment, biomicroscopy, fundus photography, optical coherence tomography (OCT), and OCT angiography. Outcomes were evaluated over 12 months preoperatively and 12 months postoperatively. The analysis included BCVA, central retinal thickness (CRT), presence of intra-, subretinal, and subpigment epithelial fluid, and the number of anti-VEGF injections.

The number of injections did not increase during the 12 months after surgery amounting to 3.1±1.1 in the brolucizumab group and 3.8±1.4 in the aflibercept group (p=0.22). BCVA improved by 0.10 in the brolucizumab group and by 0.05 in the aflibercept group. CRT decreased by 46 µm and 29 µm, respectively. Patients treated with brolucizumab demonstrated more pronounced positive structural dynamics, including a reduction in the frequency of subretinal and intraretinal fluid occurrence. No postoperative adverse events were recorded.

Phacoemulsification does not negatively affect the course of nAMD and does not require increased frequency of anti-VEGF therapy. The data confirm the safety of continuing treatment after cataract surgery. Brolucizumab demonstrated more pronounced functional and morphological improvements compared with aflibercept.