Choroidal Neovascularization after Phacoemulsification in Dry Age-Related Macular Degeneration

Whether cataract surgery accelerates the conversion of dry age-related macular degeneration to the neovascular form remains controversial. We describe a 68-year-old woman with diabetes mellitus and uncontrolled hypertension and hyperlipidemia who presented with long-standing blurred vision in the left eye. The eye was hypermetropic with an axial length of 21.00 mm and had a cataract and multiple macular drusen consistent with dry age-related macular degeneration. Uneventful phacoemulsification with intraocular lens implantation was performed. Visual acuity was 0.5 at one week but fell to counting fingers at 2 m at one month. Subretinal hemorrhage and macular thickening were present, and optical coherence tomography and optical coherence tomography angiography confirmed type 2 choroidal neovascularization. Intravitreal aflibercept 2 mg was given every four weeks for three months and then every eight weeks. After three injections visual acuity improved to 0.2, with regression of neovascularization and early retinal scarring. Eyes with drusen may develop exudative conversion soon after cataract surgery. Although causality cannot be proven from one case, careful preoperative macular imaging, counseling, and early postoperative review are advisable, and prompt anti-vascular endothelial growth factor therapy can improve vision.