I read a recent article by Saraf and associates, entitled “The Effects of Cataract Surgery on Patients With Wet Macular Degeneration,” with great interest. In their study, new development or worsening of cystoid changes was more frequently noted in eyes that had undergone cataract surgery than in eyes that had not undergone surgery. Nevertheless, visual acuity was significantly better in the eyes with the surgery than in the eyes without the surgery, suggesting that cataract surgery could be beneficial in patients with wet age-related macular degeneration (AMD).

I found it particularly interesting that the majority of the included patients were treated using the treat-and-extend protocol. Our group previously demonstrated that a longer exudation-free period before cataract surgery is associated with a lower incidence of exudation recurrence after the surgery. Based on this finding, we recommended that cataract surgery be performed after a sufficiently long exudation-free period. However, a major limitation of our previous study is that all of the patients were treated with a pro re nata protocol, that is, additional injection was not performed during the exudation-free period. Therefore, the results from our study may not be valid for patients treated with a treat-and-extend protocol.

The treat-and-extend protocol is one of the most widely used treatment methods in wet AMD. Thus, determining whether an exudation-free period before the surgery is associated with the incidence of exudation recurrence, even in patients treated with the treat-and-extend protocol, would be of great value. Saraf and associates did not present data concerning the exudation-free period. I believe that additional analyses regarding the difference in the postoperative injection frequency and the incidence of worsening subretinal fluid among eyes with different exudation-free periods may provide clinicians with useful information for determining the timing of cataract surgery.