ASRS 2024: Real-world impact of vitrectomy surgery on age-related macular degeneration

At the annual ASRS meeting, Chase Ludwig, MD, MS, shared an overview of his presentation which focused on the impact of vitrectomy surgery on progression of age-related macular degeneration (AMD). Here, he speaks to the Eye Care Network during the conference in Stockholm, Sweden.

Editor's note: The below transcript has been lightly edited for clarity.

Chase Ludwig, MD: Hi, I'm Chase Ludwig. I'm a retinal surgeon and assistant professor of ophthalmology at Stanford University, and I just spoke on the effect of vitrectomy on the progression of age-related macular degeneration. For this study, we use two databases. The TriNetX database, which is one of the largest databases with 119 healthcare organisations and 150 million patients. We supplemented this with the Stanford STARR [STAnford Research Repository] database, looking at a single institution and being able to look more granularly at clinical data.

We looked to see whether or not patients with bilateral age-related macular degeneration who underwent unilateral vitrectomy surgery, whether or not this affected the development of choroidal neovascularisation in either eye, whether or not it affected the development of geographic atrophy in either eye, and how it affected the visual acuity, as comparing visual acuity taken before surgery and at last follow up. Overall, we found in the TriNetX database that there was no statistically significant difference in the development of choroidal neovascularisation or of geographic atrophy, in either the vitrectomised or control eyes, though there were fewer incidences of choroidal neovascularisation in vitrectomised eyes compared to control eyes. And we found the same thing in the STARR database, but fewer incidences of both geographic atrophy and of choroidal neovascularisation in vitrectomised eyes as compared to control eyes at last follow up.

Then looking at visual acuity in the Stanford STARR database, we found that overall, the patients had an improvement in visual acuity after surgery, and that this was maintained at last follow up with the mean follow up of 6 years. Then in control eyes, there was a reduction in visual acuity over time at last follow up. And the difference between the change in visual acuity and the vitrectomised versus control eyes was statistically significant. So overall, we found that vitrectomy surgery did not affect the progression of age-related macular degeneration. And there was an improvement in visual acuity in vitrectomised eyes as compared to control eyes, and patients who underwent unilateral vitrectomy in the setting of having bilateral nonexudative related macular degeneration.

This stems from an important patient question, which is "Will this surgery also worsen my AMD?" You know, patients know that that surgery is very inflammatory. And they worry that this could cause them to progress to, you know, wet macular degeneration, or advanced geographic atrophy, particularly those with family members who have had those complications, or friends. So being able to reassure them that no, our surgery will not progress your age-related macular degeneration to advanced forms, and that in fact, it's very possible that it might be helpful, at least in terms of visual acuity and long term outcomes, is a wonderful thing.