Effect of Minimizing Light Exposure with Digital Visualization on Macular Function After Cataract Surgery in Patients with AMD: A Randomized Controlled Trial

Purpose: To assess whether reducing intraoperative light exposure preserves macular function after cataract surgery in patients with AMD. Methods: A total of 42 eyes of 42 patients with AMD were randomized in a prospective study. The primary outcome was the change in photopic (ERG) b-wave amplitude at one hour after surgery (V2). Secondary outcomes included ERG implicit time, multifocal ERG, visual acuity, and macular thickness, assessed at V2, V3 (day 1), and V4 (1 month). Results: Mean intraoperative light exposure was significantly lower in the 3D group than in the standard group (3938 vs 47,142 lux, p < 0.001). At 1 h after surgery, the decrease in photopic b-wave amplitude did not differ significantly between the two groups (−1.83 µV; 3D group, vs. −1.56 µV; standard group, p = 0.76). In exploratory analyses, ERG implicit time increased significantly in the standard group (p = 0.02) but remained stable in the 3D group (p = 0.24). At 1 month, an increase in macular thickness was observed only in the standard group (V1 265.9 ± 27.7 µm, V4 278.8 ± 34.9 µm; p = 0.003). Conclusions: Digital visualization significantly reduced intraoperative light exposure. However, no significant difference was observed for the primary endpoint of photopic ERG b-wave amplitude at 1 h postoperatively. Secondary findings regarding ERG implicit time and macular thickness should be considered exploratory and require confirmation in larger studies.