Long-Term Variations in Retinal Parameters after Uncomplicated Cataract Surgery

Abstract

Background: Cataract phacoemulsification surgery provides excellent refractive results; however, it also elicits changes in the posterior segment of the eye. This study aimed to determine changes in retinal parameters measured by spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) after an uncomplicated cataract surgery, including the impact of effective phacoemulsification time (EPT). Methods: The study included 44 patients without retinal abnormalities, followed up after unilateral uncomplicated cataract phacoemulsification in a single ophthalmological unit. Patients were evaluated for the following parameters at baseline and at 2 weeks, 3 months, and 12 months after the surgery: best corrected visual acuity, central retinal thickness (CRT), average central retinal thickness (CRTA), central retinal volume (cube volume (CV)), vessel density central (VDC), vessel density full (VDF), vessel perfusion central (VPC), and vessel perfusion full (VPF). The EPT recorded at each procedure was used as a covariant for the evaluation of changes in retinal parameters after the surgery. Analysis included 44 eyes for SD-OCT and 17 for OCTA evaluation, according to adopted scan quality thresholds. Results: A significant increase in CRT, CRTA, and CV was noted at each follow-up point compared with baseline. The rising tendency was observed in the first 3 months after the surgery, with a decline over the subsequent months. The VPF parameter showed a stable improvement after the surgery. The analysis of covariance did not confirm any significant effect of the EPT on variations in CRT, CV, CRTA, VDC, and VPF and there was a weak effect on the VDF parameter. Conclusions: Uncomplicated cataract surgery results in an increase in retinal thickness and volume in the first few months after the surgery, followed by a spontaneous decline in these parameters in the subsequent months. A long-standing improvement is noted in the VPF parameter.

Quantitative Measurements of Macular and Optic Nerve Head Blood Flow Parameters Following Cataract Surgery in Eye Department, Red Cross Tertiary General Hospital, Athens, Greece

“…Therefore, in agreement with our findings, most of the previous studies have shown that there is a postoperative increase of retinal capillary plexus lasting for at least 3 months [8,9,17,18], with one study [23] demonstrating preservation of the changes for up to 1 year, while another study [15] showed very limited, less than 3 months, effect.…”

“…Similar results with persistence of increased macular vessel density and thickness one to three months following cataract surgery, were observed in previous studies [8,9,23]. The study with the longest 12 months follow up so far, is the one by Gawęcki M et al [23] with postoperative evaluation with OCT-A of 17 eyes with uncomplicated cataract surgery. The authors revealed an increase in retinal thickness and volume in the first few months after the surgery, which was followed by a spontaneous decline in these parameters in the subsequent 12 months postop.…”

“…Macular thickness has been noted to reach its maximum 1 month after surgery and gradually returning to baseline [21,22]. Similar results with persistence of increased macular vessel density and thickness one to three months following cataract surgery, were observed in previous studies [8,9,23]. The study with the longest 12 months follow up so far, is the one by Gawęcki M et al [23] with postoperative evaluation with OCT-A of 17 eyes with uncomplicated cataract surgery.…”

Current Approach to the Pathogenesis of Diabetic Cataracts

“…Even though cataract surgery is highly effective and implantation of an artificial lens eliminates the possibility of refractive changes, unfortunately, diabetic patients are at a higher risk of intraoperative and postoperative complications compared to non-diabetic patients [ 29 , 30 ]. It has been shown that phacoemulsification in diabetic patients can lead to a relatively rapid progression of diabetic retinopathy, accelerate vitreous hemorrhage [ 31 ], and increase the thickness of the central retina [ 32 ]. Even uncomplicated cataract surgery leads to an increase in the concentration of inflammatory cytokines, vascular endothelial growth factor (VEGF), hepatocyte growth factor, interleukin-1 (IL-1), and pigment-epithelium-derived factor [ 33 ].…”

Long-Term Functional Hyperemia after Uncomplicated Phacoemulsification: Benefits beyond Restoring Vision

“…Recent OCTA studies addressing macular perfusion after uncomplicated phacoemulsification reached conflicting results [ 11 , 21 , 22 ]. Although conducted on a relatively large number of subjects (N = 107, N = 58, and N = 44), cataract density was assessed subjectively [ 11 , 21 ] or was not assessed at all [ 22 ], different OCTA devices were used, no analysis of QI and EA parameters before and after phacoemulsification was performed, while the subjects had lower preoperative BCVA compared to our study. The above settings could all be raised as potential sources of bias that may significantly influence quantitative measurements and confound the outcomes.…”