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Background: Cataract and neovascular age-related macular degeneration (nAMD) often co-exist and both contribute to impaired vision. It has been debated whether cataract surgery can increase nAMD activity. The purpose of this retrospective study was to investigate the impact of cataract surgery on visual acuity, treatment intensity for nAMD and macular morphology in patients with on-going treatment for nAMD. Methods: Data was obtained from the Swedish Macular Register, the Swedish National Cataract Register, optical coherence tomography (OCT) images and patient charts. All eyes were treated at the Department of Ophthalmology at the County Hospital of Vastmanland, Vasteras, Sweden. Follow-up was 6 months after surgery. The study was approved by the Swedish Ethical Review Authority. Results: In total, 156 patients (168 eyes) were included. The mean age at cataract surgery was 82 (standard deviation, SD 6) years. Both distance and near visual acuity improved after surgery. Distance visual acuity increased from 59 (SD 12) to 66 (SD 15) letters ETDRS (P < 0.001). Proportion of eyes with normal near visual acuity increased from 12 to 41%. The anti-vascular endothelial growth factor (VEGF) treatment intensity remained unchanged: mean of 3.4 (SD 1.9) and 3.3 (SD 1.7) treatments were given 6 months pre- and postoperatively, respectively. The prevalence of intraretinal fluid (IRF) in the macula increased from 22 to 31% postoperatively, while subretinal fluid, fluid under the pigment epithelium (sub-RPE fluid) and central retinal thickness were unaltered. In eyes with new IRF, improvement in visual acuity and number of anti-VEGF treatments were similar to eyes without new IRF. Conclusion: Cataract surgery improved visual acuity in patients with on-going treatment for nAMD and did not affect anti-VEGF treatment intensity. Macular morphology remained unchanged. The slight increase in intraretinal fluid after surgery was not found to affect visual acuity or anti-VEGF treatment intensity. It is hypothesized that this might indicate that it represents degenerative intraretinal cystic fluid.

Supplemental Material for Health care registers can be instrumental for endpoint capture in clinical diabetes trials: example of microvascular complications in Swedish patients with type 2 diabetes by Martin H Lundqvist, Vagia Patsoukaki, Stefan Jansson, Henrietta Norman, Elisabet Granstam, Maria K Svensson, Johan Sundström, Björn Eliasson and Jan W Eriksson in Diabetes & Vascular Disease Research

AimsTo examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12months in a real world setting.MethodsIn this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used.ResultsThe total patient group had significantly improved visual acuity and reduced retinal thickness at 4months and remains at 12months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity.ConclusionsOur study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12months after treatment start.

Aims: To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting. Methods: In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used. Results: The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity. Conclusions: Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.

Age-related macular degeneration is the leading cause of visual impairment in developed countries. It is divided into two forms, dry and wet. The etiology of the diseases is still not fully understood. Known risk factors include advanced age, genetics and tobacco smoking. New candidates like Helicobacter pylori, Cytomegalovirus, Chlamydia pneumoniae have been studied but without strong evidence of any association. Low-grade inflammation caused by obesity, for example, places a burden on the eye. We studied one known infection of the tissue supporting the teeth, periodontitis, and its effect on AMD. Surprisingly we found an association between these two diseases in males. Age-related cataract is the leading cause of visual impairment and blindness in developing countries. Cataract operation is one of the commonest procedures in medicine. It brings light to elderly people and greatly improves vision and quality of life. However, there are known complications like posterior capsule opacification (PCO), which puts a burden on healthcare providers and patients alike. Postoperative topical medication is widely used after a cataract operation and drugs are being studied to provide optimal relief of postoperative complications. In our study we found that postoperative topical steroid reduced PCO more effectively than topical NSAID drops. Cataract operations are performed using different types of intraocular lenses (IOL), namely low, intermediate and high diopter IOLs. These lenses can be divided into blue light filtering IOLs and non-blue light filtering IOLs. In animal models blue light has been found to be harmful to the retina, and after the operation there is no longer a crystalline lens to provide protection. The lenses are designed to take this into account and help to protect against wet AMD. We found in our study that low diopter IOLs resulted in more PCO than higher diopter IOLs. We also found no difference between blue light filtering IOLs and non-blue light filtering IOLs in terms of new-onset wet AMD cases. Age-related macular degeneration and cataract often co-exist. The cataract operation induces a small amount of inflammation in the eye and it has been found, albeit with differing results, that cataract operations could activate wet age-related macular degeneration. In our study we found that a cataract operation did not affect wet AMD, its progression or the number of injections needed. New anti-VEGF drugs have revolutionized the treatment of wet AMD. One of the drugs – aflibercept – is frequently used as second-line treatment due to its longer lasting effect and slightly different molecular structure compared with older drug, bevacizumab. We found in our study that aflibercept might provide protection against new-onset visual impairment. Kostea ikärappeuma on yli 65-vuotiaiden yleisin näkövammaisuuden syy teollistuneissa maissa. Uudet kasvutekijäestäjä hoidot ovat mullistaneet kostean ikärappeuman hoidon. Ongelmana on kuitenkin niiden lyhyt vaikutusaika eli pistoksia joudutaan antamaan potilaille kuukauden – kolmen kuukauden välein tilanteesta riippuen. Harmaakaihi on puolestaan yleisin näkövammaisuuden syy kehittyvissä maissa. Kaihileikkaus on yksi yleisimmistä päiväkirurgisista toimenpiteistä ja sen on todettu olevan turvallinen, kustannustehokas, näöntarkkuutta ja elämänlaatua parantava toimenpide. Harmaakaihi ja kostea ikärappeuma esiintyvät vanhusväestöllä ja usein ne esiintyvätkin yhtä aikaa. Eri tutkimukset ovat antaneet eriäviä tuloksia siitä pahentaako kaihileikkaus kostean ikärappeuman tilannetta. Tutkimuksessamme näin ei käynyt vaan kostea ikärappeuma osoitti rauhoittumisen merkkejä injektiohoitojen jatkuessa kaihileikkauksesta huolimatta. Aflibercepti on uusi kasvutekijäestäjä lääke ja se on vaikutukseltaan pidempi kuin esimerkiksi bevacizumabi. Tutkimuksessamme huomasimme, että aflibercepti saattais vähentää näkövammaisuuden esiintyvyyttä. Kaihileikkauksessa käytettävä paikallislääkitys leikkauksen jälkeen on todettu vähentävän komplikaatioita ja tutkimuksissamme totesimme, että kortisonilääke vähensi jälkikaihen esiintyvyyttä enemmän verrattuna NSAID lääkkeisiin. Kaihileikkauksessa käytettäviä tekomykiötä on erilaisia, on sinivalosuodattavia ja ei-sinivaloasuodattavia. Eläinkokeissa sinivalon on todettu olevan haitallista verkkokalvolle, mutta tutkimuksessamme näiden linssien välillä ei ollut eroa, kun verrattiin uusien kostean ikärappeuma tapausten esiintyvyyttä. Tekomykiön vahvuudella huomasimme olevan vaikutusta jälkikaihen esiintyvyyteen. Matalavahvuuksisilla tekomykiön saaneilla esiintyi enemmän jälkikaihea verrattuna normaalivahvuuksisiin ja korkeavahvuuksisiin tekomykiöihin. Ikärappeuman tunnettuja riskitekijöitä ovat korkea ikä, sukurasitus ja tupakointi. Uutena tekijänä havaitsimme, että parodontiitti saattaisi olla uusi ikärappeuman riskitekijä. Våt åldersrelaterad makuladegeneration är den vanligaste orsaken till synskada hos människor över 65 år i industrialiserade länder. Nya tillväxtfaktorhämmare har revolutionerat behandlingen av våt åldersrelaterad makuladegeneration. Problemet med dem är att deras verkningstid är kort och de måste ges varje månad – eller vart tredje månad i ögat. Gråstarr är den vanligaste orsaken till synskada och blindhet i utvecklingsländer. Starroperation är en vanlig dagkirurgisk åtgärd och den har konstaterats vara trygg och kostnadseffektiv. Starr och åldersrelaterad makuladegeneration uppträder hos äldre och de uppträder ofta samtidigt. Olika studier har gett olika resultat när det gäller huruvida en starroperation försämrar våt åldersrelaterad makuladegeneration. Vår studie ledde till att det inte spelar någon roll om man opererar våt åldersrelaterad makuladegeneration. Aflibercept är en ny tillväxtfaktorhämmare och den har längre verkningstid. Resultatet av vår studie är att aflibercept minskade förekomsten av synskada. Vid starroperation används lokala mediciner som minskar postoperativa komplikationer. I vår studie var kortisondroppar effektivare när det gäller att minska efterstarr jämfört med NSAID droppar. Vid starroperation använder man olika intraokulära linser, det finns blåljusfiltrerande och icke-blåljusfiltrerande linser. I djurstudier har man konstaterat att blåljus inte är bra för näthinnan, och i våra studier förekom det inte någon skillnad mellan dessa linser i frekvensen av ny våt åldersrelaterad makuladegeneration. Vi konstaterade att styrkan hos en intraokulär lins påverkar frekvensen av efterstarr. Hos personer som fått intraokulära linser förekom mer efterstarr än hos dem med normal och hög styrka. Riskfaktorerna för åldersrelaterad makuladegeneration är många, såsom hög ålder, ärftlighet och rökning. Vi fann att en ny riskfaktor, parodontit, infektion i tändernas stödvävnad, kunde ligga bakom åldersrelaterad makuladegeneration.