Evaluation of the effects of phacoemulsification surgery with optical coherence tomography - Angiography in patients with neovascular age-related macular degeneration

Purpose: To assess the effect of uncomplicated phacoemulsification surgery in patients with neovascular age-related macular degeneration non-invasively using Optical Coherence Tomography - Angiography (OCTA) and to investigate the visual quality of life of the patients with the questionnaire to be applied. Methods: Among the patients who were followed up with the diagnosis of neovascular membrane due to age-related macular degeneration between September 2019 and August 2020 at Yozgat Bozok University, Department of Ophthalmology, 44 patients with an indication for phacoemulsification surgery and 44 patients without cataract surgery indication were included in the study. Especially patients who took anti-VEGF treatment in the last 6 months were excluded from the study. Optical coherence tomography (OCT), OCTA and fundus autofluorescence (FOF) scans of the patients were performed before phacoemulsification and at the postoperative 1st, 3rd and 6th month controls, and their best corrected visual acuities (BCVA) were recorded. NEI VFQ-25 visual quality of life questionnaire was administered at 3 and 6 months postoperatively. OCT and OCTA parameters were evaluated and recorded by 2 different researchers. Results: At the beginning of the study, there was no difference between the groups in terms of age, gender, choroidal neovascular membrane (CNV) type and area, and CNV flow area measurements. There was no significant difference between the surgical and control groups in terms of membrane area during follow-up (p>0,05). However, there was a statistically significant difference between the baseline and the 6th month in the surgery group in terms of membrane area change (p<0,05). There was no significant difference between the surgical and control groups in terms of flow area (p>0,05). At the 6th month visit, a significant decrease in the small-caliber vessels (p<0,05) and a significant increase in perilesional halo (p<0,05) were detected in the surgical group; There was no significant change in other activation criteria (p> 0,05). Superficial Foveal Density (SFD) measurements were not statistically significant in the surgical group from the preoperative period to the 6th month (p˃0,05). The 6-month neovascular membrane areas of the surgical and control group patients with perilesional halo, evaluated only by OCTA, were significantly different (p˂0,05). There was no significant difference between baseline and 6th month in OCT measurements of subfoveal choroidal thickness (p> 0,05). There was a significant difference between the groups in terms of subfoveal choroidal thickness between the baseline and the 3rd month (p<0,05). There was no statistically significant difference between the groups for other OCT measurements (p> 0,05). In NEI VFQ-25 subscale analysis, no significant change was observed in the control group, while a significant increase was observed in the distance activity score in the surgical group. Conclusion: Cataract surgery is considered as one of the risk factors for neovascular AMD progression, regardless of the presence or absence of complications. Although cataract surgery improves the visual quality of life of patients with age-related macular degeneration, delaying phacoemulsification would be a more appropriate approach in patients with cataracts that do not affect daily life. Keywords: Age-related macular degeneration, phacoemulsification, optical coherence tomography angiography.