Surreal illustration of cataract surgery and macular degeneration.

Vision After Cataract Surgery: What You Need to Know About AMD and PCV

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Exploring the impact of cataract surgery on patients with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy."

A recent study highlighted that cataract surgery can lead to improved vision for individuals with neovascular age-related macular degeneration (AMD). Following cataract surgery, patients experienced an improvement in visual acuity, as measured by ETDRS letters. This is encouraging news, as it suggests a potential benefit for those with both cataracts and neovascular AMD.

However, the study also revealed a nuanced picture. While cataract surgery didn't alter the overall frequency of anti-VEGF (vascular endothelial growth factor) injections, a closer look showed that some patients who had been injection-free for over a year prior to cataract surgery needed to resume these injections afterward. Specifically, among 19 patients, 11 required a resumption of anti-VEGF treatment.

This observation raises an important question: are there specific clinical factors or features detectable on optical coherence tomography (OCT) that could help predict which patients might require renewed anti-VEGF injections after cataract surgery? Identifying these factors would be invaluable in optimizing treatment strategies and managing patient expectations.

PCV and the Risk of Submacular Hemorrhage

Surreal illustration of cataract surgery and macular degeneration.

It's important to consider the presence of polypoidal choroidal vasculopathy (PCV), a subtype of AMD that occurs more frequently in Asian populations. One potential complication of active PCV is the development of sudden, massive submacular hemorrhage, which can lead to permanent vision loss.

Research indicates that the frequency of massive submacular hemorrhage in PCV patients varies, with reported rates between 7.5% and 13.1%. While the exact risk factors remain unclear, a sudden change in intraocular pressure is thought to play a role.

Intraocular pressure is known to fluctuate during cataract surgery.
Shearing forces resulting from these pressure changes may damage choroidal vessels.
Patients with hypertension and arteriosclerosis may be particularly vulnerable due to increased vessel fragility.

A study by Kim et al. (2012) reported a case where a patient with asymptomatic PCV developed submacular hemorrhage one week after cataract surgery. This patient required treatment with photodynamic therapy and intravitreal bevacizumab.

Optimizing Care for AMD and PCV Patients

Cataract surgery can be beneficial for patients with AMD, but careful consideration is necessary, especially in those with PCV. Assessing the activity level of PCV lesions is crucial in determining the optimal management strategy before proceeding with cataract surgery.

Further research is needed to identify clinical factors and OCT features that can predict the need for resumed anti-VEGF injections after cataract surgery. Understanding these factors will enable ophthalmologists to better tailor treatment plans and monitor patients at higher risk.

By carefully evaluating each patient's individual circumstances, including the presence and activity of PCV, ophthalmologists can optimize visual outcomes and minimize the risk of complications following cataract surgery.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/aos.13540, Alternate LINK

Title: Visual Outcomes In Patients With Neovascular Age-Related Macular Degeneration

Subject: Ophthalmology

Journal: Acta Ophthalmologica

Publisher: Wiley

Authors: Colin S. Tan, Wei Kiong Ngo, Louis W. Lim

Published: 2017-08-22

Everything You Need To Know

How does cataract surgery affect vision for people with neovascular age-related macular degeneration (AMD)?

Cataract surgery can improve visual acuity, as measured by ETDRS letters, for individuals with neovascular age-related macular degeneration (AMD). This improvement signifies a potential benefit for those with both cataracts and AMD, allowing for clearer vision post-surgery. The recent study highlights the positive impact of cataract surgery in the context of AMD, emphasizing the potential for enhanced visual outcomes. Further research aims to understand the nuances of these benefits.

Does cataract surgery influence the need for anti-VEGF injections in patients with AMD?

While cataract surgery offers visual benefits for patients with neovascular age-related macular degeneration (AMD), it may affect the need for anti-VEGF injections. Some patients who were previously injection-free for over a year might require a resumption of these treatments after cataract surgery. In a study, a portion of patients resumed injections after cataract surgery, underscoring the importance of monitoring and adapting treatment strategies post-surgery.

What is polypoidal choroidal vasculopathy (PCV), and why is it important?

Polypoidal choroidal vasculopathy (PCV) is a subtype of AMD, particularly prevalent in Asian populations. PCV carries a risk of sudden, massive submacular hemorrhage, which can lead to permanent vision loss. The presence of PCV necessitates careful consideration because the surgery may increase the risk of complications.

What are the potential risks associated with cataract surgery for patients with polypoidal choroidal vasculopathy (PCV)?

The potential for fluctuating intraocular pressure during cataract surgery, along with possible shearing forces, can affect the choroidal vessels. Patients with pre-existing conditions like hypertension and arteriosclerosis may be more susceptible due to increased vessel fragility. A study by Kim et al. (2012) demonstrated that cataract surgery could lead to complications in PCV patients, with a patient developing submacular hemorrhage after cataract surgery, highlighting the need for cautious management.

How should doctors manage cataract surgery for patients who also have polypoidal choroidal vasculopathy (PCV)?

Assessing the activity level of polypoidal choroidal vasculopathy (PCV) lesions before cataract surgery is critical. Careful evaluation helps determine the optimal approach, balancing the benefits of cataract removal with the risks associated with PCV. Such assessments ensure a tailored management strategy, mitigating potential complications and improving patient outcomes. It is a necessary step to ensure the patient receives the best care, weighing the risk of submacular hemorrhage with the improvement cataract surgery can provide.