Influence of cataract surgery on macular thickness: a 6-month follow-up

Posterior segment parameters after uveitic cataract surgery: A prospective study with 1-year results

PURPOSE

To evaluate the changes in posterior segment after uncomplicated cataract surgery in uveitic patients.

METHODS

Retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), central macular thickness (CMT), and choroidal thickness (CT) of 38 eyes of 28 patients were measured pre- and postoperatively on day 1, week 1, and month 1, 3, 6, 9, and 12.

RESULTS

The RNFLT increased after surgery. Although the measurements taken were higher than the baseline CMT at all postoperative times, no significant difference was detected between the paired comparisons. The GCLT was found to be higher than the baseline value in all quadrants at the 12th month. A decrease in CT was observed at 5 measured points on the 1st day compared to the baseline.

CONCLUSION

During the 1-year follow-up, the effect of cataract surgery on the retina and choroid in uveitic eyes was most evident at the postoperative month 1.

Impact of Phacoemulsification Parameters on Central Retinal Thickness Change Following Cataract Surgery

Cataract surgery can lead to inflammatory processes in the retina due to its invasive nature, resulting in prolonged recovery times and reduced functional outcomes. The aim of the current study is to explore the impact that phacoemulsification parameters have on macular thickness following surgery. This prospective single-center study enrolled 46 healthy patients (46 eyes) who underwent uneventful cataract surgery. Retinal thickness was assessed using optical coherence tomography (OCT) preoperatively, as well as 1, 4, and 12 weeks after surgery. The macula was divided into a central (CMT), inner (IMT), and outer ring (OMT). Cataract density was automatically determined using an anterior segment OCT and a custom MATLAB script. Corrected distance visual acuity (CDVA), intraocular pressure (IOP) as well as cumulative dissipated energy (CDE), ultrasound time (UT), and fluids used during phacoemulsification were recorded. Retinal thickness and volume increased significantly following cataract surgery, reaching its maximum 4 weeks post-operatively. Statistically significant correlations were found between the CDE and IMT, OMT and retinal volume change (rIMT = 0.356, rOMT = 0.298, rvolume = 0.357 with p < 0.05) as well as between the ultrasound time and IMT, OMT, and retinal volume change (rIMT = 0.369, rOMT = 0.293 and rvolume = 0.409 with p < 0.05). Changes in CMT did not correlate with any surgical metrics. Additionally, no correlation was found to the amount of fluid used, whether CDVA or IOP. However, a link between nuclear cataract density and changes in OMT (r = 0.310, p < 0.05) was established. How ultrasound energy impacts the choroidea, and to what extent retinal metabolism changes after surgery, needs to be explored in future studies.

Chorioretinal Folds in the Trabeculectomized Eye with Normal Intraocular Pressure after Phacoemulsification

Background and Objectives: This case report discusses possible causes of chorioretinal fold (CRF) formation. Materials and Methods: A case report. Results: A 48-year-old man presented with a history of high myopia and primary open-angle glaucoma in both eyes. He underwent a trabeculectomy followed by phacoemulsification in both eyes. Two months later, he complained of blurred vision in the right eye. The intraocular pressure (IOP) was 17 mmHg in the left eye and 9 mmHg in the right eye. Refraction showed a hyperopic shift in both eyes. Slit-lamp examination showed a deep anterior chamber without cells and a well-functional bleb without leakage. Fundus examination revealed CRFs in the macula of the right eye. No papilledema, choroidal lesions, or other retinal lesions were found. Wrinkling of CRFs at the macula, an increase in central foveal thickness, and a fluid cleft were demonstrated by spectral-domain optical coherence tomography. After using steroid eye drops, the IOP in the right eye and refraction in both eyes recovered to the baseline level. Visual acuity improved in both eyes. Conclusions: CRFs in trabeculectomized eyes with normal IOP after phacoemulsification have not been reported. This case demonstrated that the trabeculectomized eye remains at risk of CRF formation, even if the IOP is normal without hypotony. The importance of a detailed fundus examination in patients with unexplained blurred vision may be necessary after having undergone these procedures. The early recognition of the cause of visual loss may facilitate immediate treatment and may avoid irreversible changes with permanent visual loss.

Changes in choroidal and foveal retinal thickness after cataract surgery: Our results

INTRODUCTION

Cataract surgery is the most common ophthalmic surgical procedure worldwide. In addition, the retina and choroid are the tissues most susceptible to damage during cataract surgery. However, conflicting results have been found about the relationship between choroidal thickness (CT), retinal thickness (RT), and cataract surgery.

AIM

To evaluate the changes in CT and foveal retinal thickness (FT) following cataract surgery in standardized conditions.

METHODS

Twenty eyes from 20 patients who experienced uneventful cataract surgery and twenty eyes from 20 age- and sex-matched healthy volunteers were recruited in the study. Optical coherence tomography measurements were obtained for 1 day, 1 week, and 1 month postoperatively and compared with the preoperative and control values. The main outcome measure was through the mean change in CT and FT.

RESULTS

The FT values did not change throughout the follow-up. A statistically significant increase in CT at the macular (P = 0.003) and temporal 1 mm region (P = 0.04) was observed at 1 week following the surgery. However, it decreased to nearly preoperative values at 1 month postoperatively.

CONCLUSION

Although the FT remains stable following uneventful phacoemulsification, the CT changes minimally in the early postoperative period. However, this effect is transient and does not appear to be clinically significant in routine conditions.

Influence of one or two horizontal muscle surgeries on OCT findings

We investigate the effects of differences between one or two horizontal rectus muscle surgeries (recession ± resection) on the central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and retinal nerve fiber layer (RNFL). Measurements of the CMT, SFCT, and RNFL in patients who underwent horizontal rectus muscle surgery were obtained using optical coherence tomography (OCT). Patients were grouped as those who had undergone rectus muscle recession surgery (Group 1) and those who had undergone rectus muscle recession + resection surgery (Group 2). The CMT, SFCT, and RNFL in patients were measured preoperatively and 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. A total of 65 eyes of 50 patients were analyzed retrospectively. The average age of the 25 patients in Group 1 was 8.96 ± 7.966 years (min 3, max 38). The average age of the 25 patients in Group 2 was 15.17 ± 6.806 years (min 2, max 34). The comparison of the preoperative and the 1-day and 1-week postoperative values revealed an increase in CMT and SFCT in Group 1 and Group 2. There were no significant differences between the two groups. It was observed that this increase reached the preoperative values after 1-3 months and 6 months in both groups. There was no statistically significant change in the RNFL. Rectus muscle surgery (recession±resection) caused an increase in CMT and SFCT in the early stage, which was possibly caused by the altered choroidal microcirculation resulting from mechanical traction during surgery and by postoperative inflammation. There was no difference between one or two muscle surgeries.

Influence of cataract surgery on macular vascular density in patients with myopia using optical coherence tomography angiography

The aim of the present study was to evaluate macular vascular density (MVD) variation after uneventful cataract surgery using optical coherence tomography angiography (OCTA) in patients with high myopia. Patients with cataracts scheduled for cataract surgery were divided into a high-myopia group [spherical equivalent (SE)≤-6.0 diopter (D) and axial length (AL)≥25 mm] and a low-myopia group (SE>-6.0 D and AL<25 mm). All patients were examined for MVD and retinal thickness (RT) with OCTA pre-operatively and post-operatively (1 day, 1 week, and 1 and 3 months after surgery). A total of 55 eyes from 44 patients were included. MVD and RT both changed after cataract surgery. The mean change in superficial vascular density (SVD) in patients with high myopia was significantly lower than that in the low-myopia group at the four post-operative time-points (all P<0.05). In addition, the RT of eyes with high myopia exhibited a different variation compared with that of the low-myopia group. Significant correlations were identified between AL, RT, intraocular pressure and SVD after surgery. In conclusion, superficial retinal perfusion in patients with high myopia was significantly lower than that in low myopia patients, which may lead to complications caused by poor perfusion.

Comparison of macular thickness change by optical coherence tomography after uncomplicated cataract surgery in eyes with and without exfoliation syndrome

PURPOSE

To evaluate the effect of exfoliation syndrome (ES) on macular thickness after uncomplicated cataract surgery.

METHODS

87 patients (87 eyes) who underwent uncomplicated cataract surgery were included in the study. Optical coherence tomography (OCT) films were taken in addition to the routine ophthalmologic examination before the surgery and at postoperative 1st week, 1st, 3rd and 6th months. Mean macular thickness, central macular thickness and macular volume values obtained from the 6 × 6 mm macular map in the OCT measurements were recorded. The cases were divided into two groups as Group 1: cases without ES and Group 2: cases with ES. The macular values obtained from the OCT measurements of the two groups were compared with statistical methods.

RESULTS

Eighty-seven eyes were included in the study; while 51 had no ES (Group 1), 36 had ES (Group 2). The mean age of all cases was 66.70 ± 9.13 years. While the mean macular thickness, central macular thickness and macular volume were similar at the preoperative visit and the postoperative 1st week of all cases (each p value > 0.05); these values were higher at the postoperative 1st, 3rd and 6th month compared to the preoperative and the postoperative 1st week values (each p value < 0.05). The highest values were obtained at the postoperative 1st month; while the values of 1st, 3rd and 6th months were statistically similar (each p value > 0.05). No statistically significant difference was observed between Group 1 and Group 2 in terms of macular volume, central macular thickness and average macular thickness in these periods.

CONCLUSION

Exfoliation syndrome has not been evaluated as a risk factor for an increase in macular thickness after uncomplicated cataract surgery.

Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis

Purpose

To investigate the effect of cataract surgery on subfoveal choroid thickness (SFCT) using enhanced-depth imaging optical coherence tomography (EDI-OCT).

Materials and Methods

Relevant publications were searched systematically through various databases from inception to March 2018. The unit of choroidal thickness measurements is micrometers. Studies comparing SFCT before and after cataract surgery were retrieved. All qualified articles were analyzed using RevMan 5.3.

Results

A total of 13 studies with 802 eyes from 646 patients were identified for inclusion. There was a significant increase of SFCT at 1 week (MD = 6.62, 95% CI: 1.20-12.05, P=0.02, I² = 0%), 1 month (MD = 8.30, 95% CI: 3.20-13.39, P=0.001, I² = 0%), and 3 months (MD = 8.28, 95% CI: 1.84-14.73, P=0.01, I² = 0%) after cataract surgery. In subgroup analysis, SFCT in Asians and patients without nonsteroidal anti-inflammatory drugs (NSAIDs) in postoperative medication was significantly thicker (P < 0.05). No statistically significant increase of SFCT was found in diabetic mellitus (DM) patients for 1 day (P=0.89), 1 week (P=0.59), 1 month (P=0.52), and 3 months (P=0.42) after cataract surgery.

Conclusions

This meta-analysis suggested that SFCT increased since 1 week after the cataract surgery and the increase lasted for at least 3 months. Asians and patients without NSAIDs in postoperative medication were more likely to have a thicker SFCT after cataract surgery, whereas DM patients were less likely to increase in SFCT.

The Effects of Uncomplicated Cataract Surgery on Retinal Layer Thickness

Purpose

Our aim was to assess changes in the total retinal thickness (TRT), total retinal volume (TRV), and retinal layer thickness after uncomplicated cataract surgery.

Methods

A total of 32 eyes of 32 patients who had undergone uncomplicated phacoemulsification surgery and intraocular lens implantation in one eye were enrolled. Effective phacoemulsification time (EPT) and total energy (TE) were recorded. Thickness and TRV were measured using optical coherence tomography. Data were collected preoperatively and at postoperative day 1, 7, 30, 90, and 180.

Results

The study results showed a decrease in TRT, TRV, and most retinal layer thicknesses at the first postoperative day visit and then increasing at week 1, and months 1 and 3, and then relatively decreasing at month 6 although not returning to preoperative levels. The least affected layers were the retinal pigment epithelium and outer plexiform layer. There was a positive correlation between EPT and TE and ganglion cell layer in a 1 mm circle and inner nuclear layer in a 1-3 mm circle (p < 0.05).

Conclusion

The results suggest that long-term follow-up of more than 6 months is necessary after cataract surgery to see whether total retinal and segmental values return to preoperative levels. This study was registered with Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000763246.

Variations in Choroidal and Macular Thickness Maps after Uneventful Phacoemulsification

OBJECTIVE

To investigate changes in retinal and choroidal thickness maps following uncomplicated phacoemulsification using enhanced depth imaging optical coherence tomography (EDI-OCT).

METHODS

A prospective study was done on 66 eyes. EDI-OCT was performed preoperative, 1 week, 1 month, and 3 months postoperative measuring retinal and choroidal thickness at the fovea and the 9 ETDRS subfields.

RESULTS

Subfoveal choroidal thickness (SFCT) showed statistically insignificant increase after 1 week (‎‎P = 0.473), but the increase was statistically significant after 1 month (P = 0.014). However, after 3 months, there was non-significant difference from baseline (P = 0.073). Foveal retinal thickness (FT) demonstrated statistically insignificant increase after 1 week (P = 0.094), but statistically significant increase was noted after 1 and 3 months (P = 0.000).

CONCLUSION

Uneventful phaco induced statistically significant increases in FT and SFCT from the first postoperative month; however, 3 months postoperative the increase in retinal thickness was maintained but the increase in choroidal thickness became statistically insignificant.

Changes of the Macular Ganglion Cell-Inner Plexiform Layer Thickness after Cataract Surgery in Glaucoma Patients

Purpose. To investigate the effect of uneventful cataract surgery on macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in glaucoma patients. Methods. This retrospective study included 65 eyes of 65 subjects who underwent uneventful cataract surgery, including 13 glaucoma eyes and 52 normal eyes. Using spectral domain optical coherence tomography, the mGC-IPL thickness was measured and compared between glaucoma and normal eyes preoperatively as well as 1 month and 3 months postoperatively. Linear regression analysis was used to determine the factors associated with postoperative change in mGC-IPL thickness. Results. The mean mGC-IPL significantly increased in both groups 1 month and 3 months after surgery (all P values equal to or less than 0.001). The postoperative changes between groups were not significantly different (P = 0.171). In the multivariate regression analysis, preoperative mGC-IPL thickness showed a significant association with the change of average mGC-IPL thickness 1 month and 3 months after surgery (all P values < 0.001). Conclusions. The mean mGC-IPL thickness was increased after cataract surgery, and the postoperative mGC-IPL thickness changes were associated with preoperative mGC-IPL thickness in both groups and axial length in normal eye. The effects of cataract surgery on mean mGC-IPL thickness were not different in glaucomatous and normal eyes.