Evaluation of Macular Changes After Uncomplicated Phacoemulsification Surgery by Optical Coherence Tomography

Abstract

INTRODUÇÃO Edema macular (EM) permanece sendo a causa mais frequente de baixa visão após cirurgia de catarata (1,2). O EM desenvolve-se devido à quebra da barreira hematorretiniana causando acúmulo de líquido no espaço extracelular da retina e formação de cistos nas camadas plexiforme externa e nuclear interna (3,4). A incidência de EM à angiografia (3-70%) e de EM clinicamente relevante (0-22%) variam substancialmente na literatura, dependen-do da sua definição, técnica da cirurgia, método diagnóstico utilizado e comorbidades associadas (1,2,5-7). A incidência de EM pós-operatório aumenta quando a cirurgia de catarata é acompanhada no intraoperatório de rotura de cápsula RESUMO Objetivo: Avaliar o edema macular após cirurgia não complicada de facoemulsi-ficação com implante de lente intraocular por meio da tomografia de coerência óptica spectral domain (OCT-SD). Métodos: Foi realizado estudo prospectivo em 62 olhos de pacientes submetidos à facoemulsificação com implante de lente intraocular. Os pacientes foram avaliados antes e após a cirurgia, no primeiro dia, e na primeira, segunda e quarta semanas. Acuidade visual (AV), células na câmara anterior e tomografia de coerência óptica macular cubo 200x200 foram medidos. Resultados: Após a cirurgia de facoemulsificação houve melhora da acuidade visual, inflamação decrescente, e a espessura e o volume macular aumentaram. Ocorreu um caso de edema macular cistoide. Houve correlação inversa fraca entre a acuidade visual e a espessura macular central, e entre a acuidade visual e o volume macular. Foi observada correlação direta fraca entre a inflamação e o volume macular. Conclusão: Edema macular subclínico desenvolve-se mesmo após cirurgia de catarata não complicada em pacientes não predispostos. A tomografia de coerência óptica spectral domain foi capaz de detectar pequenos aumentos na espessura macular no período avaliado. Descritores: Facoemulsificação; Edema macular; Tomografia de coerência óptica; Implante de lente intraocular; Período pós-operatório; Acuidade visual ABSTRACT Purpose: To evaluate macular edema after uncomplicated phacoemulsification with implantation of intraocular lens by spectral domain optical coherence tomography (OCT). Methods: Prospective study was conducted in 62 eyes of patients underwent phaco-emulsification with implantation of intraocular lens. Patients were evaluated before surgery and after surgery at day 1, week 1, week 2 and week 4. Visual acuity (VA), anterior chamber cells and 200x200 macular cube optical coherence tomography were measured. Results: After phacoemulsification there was an improvement in visual acuity, de creasing inflammation, and increased macular thickness and macular volume. There was one case of cystoid macular edema. There was a weak inverse correlation between visual acuity and central macular thickness, and between visual acuity and macular volume. We observed a week direct correlation between inflammation and macular volume. Conclusion: Subclinical macular edema develops even after uncomplicated cataract s...

Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsification

“…In previous studies, subclinical macular thickening has been reported after uncomplicated cataract surgery. [9][10][11][12][13][14] Interestingly, in our study, at day 1 after surgery, mean retinal thickness of all macular subfields of the operated eyes decreased significantly in comparison to the fellow eyes. Retinal thickness on the first post-operative day showed significant increase in two studies 9,10 and mild statistically insignificant decrease in one study.…”

“…Retinal thickness on the first post-operative day showed significant increase in two studies 9,10 and mild statistically insignificant decrease in one study. 11 Therefore, our study is the first to show statistically significant decrease. It would seem reasonable to presume that retinal thickness does not vary or increase due to surgery-induced inflammation shortly after cataract extraction.…”

“…[6][7] Light toxicity and vitreo-macular traction may also have a role. 4,8 Optical coherence tomography (OCT) has been used to study macular changes after uncomplicated cataract surgery and the results are heterogeneous; retinal thickness is increased in some studies, [9][10][11][12][13][14] whereas in others a decrease is reported. 15 These studies are difficult to compare due to the use of different generations of OCT instruments, data analysis, post-operative treatment regimens and probably a high incidence of measurement artefacts.…”

Outcomes following cataract surgery in choroideremia

“…This compared with rates detected by SD-OCT in normal eyes after cataract surgery of between 4 and 11%. 14,15 Although CMO is a recognized late complication of choroideremia itself, 16 no patients in this cohort developed postoperative CMO. …”

Macular Thickness Change After Phacoemulsification

“…Perente. [6] In the present study, there were 7 diabetics among which 4 showed increase in macular thickness post-operatively especially in inner nasal, inner inferior and central foveal areas. A study conducted by Soon II Kwon.…”