Early retinal and choroidal OCT and OCT angiography signs of inflammation after uncomplicated cataract surgery

Small Hyperreflective Retinal Foci as in vivo imaging feature of resident microglia activation in geographic atrophy

Geographic atrophy (GA), the atrophic late stage of age-related macular degeneration (AMD), is one of the leading causes of vision loss in developed countries. Based on genetic, histological and preclinical studies, the role of the innate immune system in the development and progression of GA is well established. Microglia, the principal resident immune cells, are recognized as key players in innate immunity and contributors to AMD development. Optical coherence tomography (OCT) allows to identify small hyperreflective retinal foci (HRF) with specific features known as aggregates of activated microglial cells as possible in vivo imaging feature of local neuroretinal inflammation. The purpose of this study was to evaluate the presence and amount of small HRF in the eyes of patients with different macular atrophic phenotypes. Patients with GA in both eyes (bilateral GA: B-GA group), patients with GA in one eye and macular new vessels (MNV) in the fellow-eye (unilateral GA: U-GA group) and patients with extensive macular atrophy with pseudodrusen (EMAP), a rare and aggressive variant of atrophic AMD, were retrospectively analyzed. HRF, defined as isolated punctiform elements of small dimensions (≤30 μm) with intermediate reflectivity (similar to that of the nerve fiber layer) and without a shadow cone, were manually identified and quantified. The amount of HRF was correlated to best corrected visual acuity (BCVA), GA lesion size, measured both at near infrared reflectance (NIR), and blue wavelength fundus autofluorescence (FAF) images, to some GA features (multifocal versus unifocal GA; presence versus absence of foveal sparing) and to central retinal thickness (CRT). Forty-six patients (26 in the B-GA group, 16 in the U-GA group and 4 in the EMAP group) were studied. Patients with EMAP were younger compared to patients with B-GA and to patients with U-GA (63.5 ± 6.8 years vs 80.4 ± 8.4 years B-GA, and vs 83.3 ± 6.1 years U-GA; p = 0.0004 and p= <0.0001, respectively). Mean BCVA, mean GA area at NIR and at FAF images, foveal sparing and multifocal versus unifocal GA distribution and mean CRT were not significantly different among groups. GA area was wider on NIR versus FAF in all groups, significantly in B-GA and U-GA groups (11.7 ± 7.6 mm2 vs 10.6 ± 7.1 mm2, p = 0.0087 in B-GA; 7.8 ± 9.2 mm2 vs 7.7 ± 9.4 mm2, p = 0.004 in U-GA). The number of HRF was significantly higher in U-GA compared to B-GA and to EMAP (47.4 ± 7.1 vs 31.6 ± 7.3 B-GA and 28.0 ± 4.9 EMAP, p < 0.0001 for both), while mean HRF number did not significantly differ between B-GA and EMAP (p = 0.1960). HRF count correlated only to CRT, positively in B-GA and negatively in U-GA group. The increase of small HRF, which mirrors retinal microglial activation, characterizes eyes with unilateral GA (and MNV in the fellow eye) but not eyes with bilateral GA or EMAP. The role of activated microglia in the retina of GA eyes needs to be better investigated, mainly considering the actual and new therapeutic strategies with which to reduce either the development or progression of the atrophic macular changes.

Long-term impact of low-energy femtosecond laser and manual cataract surgery on macular layer thickness: A prospective randomized study

PURPOSE

To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation.

METHODS

This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm.

RESULTS

Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery.

CONCLUSION

Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified.

Choroidal and retinal vascular changes in HLA-B27-associated anterior uveitis

PURPOSE

To quantitatively analyze choroidal and retinal vascular changes in HLA-B27-associated anterior uveitis.

STUDY DESIGN

A retrospective study.

METHODS

Medical records of 51 eyes with unilateral HLA-B27-associated anterior uveitis, their fellow eyes and 47 sex and age-matched healthy eyes were retrospectively reviewed. Their choroidal and retinal vasculature were analyzed using swept-source (SS) optical coherence tomography (OCT) and OCT angiography (OCTA) scans.

RESULTS

Deep capillary plexus (DCP) vessel density (VD) (p < 0.001), choroidal vascularity index (CVI) (p = 0.012), and choriocapillary flow deficit (CCFD) (p < 0.001) of uveitic and fellow eye group were significantly higher than those of control group. On the contrary, superficial capillary plexus (SCP) VD (p < 0.001) of uveitic and fellow eye group were significantly lower than of control group. The vascular parameters of uveitis and fellow eye group showed no significant difference between uveitic and resolution period.

CONCLUSION

Certain choroidal and retinal vascular parameters were significantly changed in both HLA-B27-associated anterior uveitis without posterior segment involvement and the quiet fellow eyes, suggesting their possible effects as a systemic inflammatory disorder.

Network pharmacology and biochemical experiments reveal the antiapoptotic mechanism of huperzine A for treating diabetic retinopathy

BACKGROUND/AIMS

Diabetic retinopathy is the most common eye disease that causes blindness in the working population. Neurodegeneration is the early sign of diabetic retinopathy, but no drug has been approved for delaying or reversing retinal neurodegeneration. Huperzine A, a natural alkaloid isolated from Huperzia serrata, displays neuroprotective and antiapoptotic effects in treating neurodegenerative disorders. Our study aims to investigate the effect of huperzine A in preventing retinal neurodegeneration of diabetic retinopathy and its possible mechanism.

METHODS

Diabetic retinopathy model was induced by streptozotocin. H&E staining, optical coherence tomography, immunofluorescence staining and angiogenic factors were used to determine the degree of retinal pathological injury. The possible molecular mechanism was unrevealed by network pharmacology analysis and further validated by biochemical experiments.

RESULTS

In our study, we demonstrated that huperzine A has a protective effect on the diabetes retina in a diabetic rat model. Based on the network pharmacology analysis and biochemical studies, huperzine A may treat diabetic retinopathy via key target HSP27 and apoptosis-related pathways. Huperzine A may modulate the phosphorylation of HSP27 and activate the antiapoptotic signalling pathway.

CONCLUSION

Our findings revealed that huperzine A might be a potential therapeutic drug to prevent diabetic retinopathy. It is the first-time combining network pharmacology analysis with biochemical studies to explore the mechanism of huperzine A in preventing diabetic retinopathy.

Early Postoperative Changes in Macular Choroidal Thickness After Uncomplicated Phacoemulsification in Patients With and Without Glaucoma: A Swept-Source Optical Coherence Tomography Study

Purpose The objective of this study was to examine the impact of uncomplicated phacoemulsification on macular choroidal thickness (CT) within the first three postoperative months and to investigate its relationship with postoperative cystoid macular edema (CME) in both glaucomatous and healthy subjects, utilizing swept-source optical coherence tomography (SS-OCT). Methods The non-randomized prospective study involved 82 patients, selected via convenience sampling from the First Department of Ophthalmology, Medical School of Athens, "G. Gennimatas" Hospital, Athens, Greece, between May 2018 and May 2022, undergoing phacoemulsification and intraocular lens (IOL) implantation. The inclusion criteria encompassed patients aged 50 years or above, with or without glaucoma. Patients with ocular pathologies that could influence macula or CT measurements were excluded. Data collection focused on retinal and CT variables of the macular area, measured using SS-OCT. Baseline measurements were established preoperatively, with follow-up assessments at one week, one month, and three months postoperatively to monitor CT and macular edema onset. Results A total of 82 eyes from 82 patients with a mean age of 79.1±8.3 years were included. The study population was divided into a glaucoma group (n=28 eyes) and a control group (n=54 eyes). Our findings indicate a consistently significant increase in macular CT measurements one month after cataract surgery, observed in both glaucomatous and non-glaucomatous eyes. In the first postoperative week, statistically significant changes in CT were observed only in patients with CME. Subsequently, at one-month interval, both patient groups, those with and without CME, exhibited statistically significant changes in CT across all macular sectors. CME was detected in 10 out of 28 eyes in the glaucoma group and in 16 out of 54 eyes in the control group. When evaluating the impact of postoperative CME on groups of glaucomatous and non-glaucomatous eyes, it was observed that glaucomatous eyes exhibited a significantly larger magnitude of change in subfoveal CT (SFCT) (p=0.03) at one month (relative to baseline) compared to non-glaucomatous eyes. There was also a 31% increase in the odds of developing CME for glaucoma patients; this result was not statistically significant (odds ratio {OR}, 1.31; 95% confidence interval {CI}, 0.50-3.47; p=0.57). Conclusions During the early postoperative period, the study revealed a significant increase in CT at one month after phacoemulsification in both glaucomatous and non-glaucomatous eyes. When CME was present, a significantly more pronounced magnitude of change in SFCT was observed at one month in glaucomatous eyes, as opposed to non-glaucomatous eyes. This observation suggests a possible selective susceptibility of glaucomatous eyes in the early postoperative period that requires further research.

Optical coherence tomography angiography parameters after cataract surgery

PURPOSE

To evaluate the changes in macular blood flow after cataract surgery through optical coherence tomography angiography (OCT-A).

METHODS

In this prospective case series, 50 patients who underwent uncomplicated cataract surgery by the resident were included. OCT-A images and complete ocular examinations were performed at baseline, 1 and 3 months postoperatively. The changes in OCT-A parameters including foveal avascular zone (FAZ) area, vessel density (VD) of superficial and deep plexus, and central macular thickness were assessed before and after surgery. Cataract grading, intraocular inflammation, and duration of surgery were analyzed.

RESULTS

FAZ was significantly reduced from 0.36 ± 0.13 mm2 at baseline to 0.32 ± 0.12 mm2 at month 1 (P < 0.001) and this reduction continued until month 3. In the superficial layer, vessel density of the fovea, parafovea, and whole image significantly increased from 13.9 ± 6.8, 43.7 ± 4.7, and 43.2 ± 4.4 at baseline to 18.4 ± 7.9, 45.7 ± 4.9, and 44.9 ± 4.5 at month 1. The increase in the vessel density of the deep layer was similar to the superficial layer. Accordingly, CMT at the fovea was significantly increased from 240.5 ± 21.99 µm at baseline to 253.1 ± 23.2 microns at month 1 (P < 0.001) and the increase significantly continued and reached 259.5 ± 22.6 µm at month 3 (P < 0.001). Accordingly, the FAZ area significantly reduced one month postoperatively. In regression analysis, CMT changes positively correlated with cataract grading. FAZ area negatively correlated with intraocular inflammation on the first postoperative day.

CONCLUSION

The present study shows that CMT and vessel density of the macula significantly increase after uncomplicated cataract surgery, while the FAZ area reduces. Postoperative inflammation could be the possible explanation for the findings of this study.

Prospective clinical study of retinal microvascular alteration after ICL implantation

Purpose: To evaluate the retinal microvascular alteration after implantable collamer lens (ICL) implantation in moderate to high myopia patients using quantitative optical coherence tomography angiography (OCTA). Methods: This prospective cohort study included 50 eyes of 25 patients with preoperative spherical equivalent ≥ -3.00 D. Patients underwent bilateral ICL implantation at the Department of Ophthalmology, Peking University Third Hospital, from November 2018 to July 2019. OCTA was used to image the superficial and deep retinal capillary plexuses before ICL implantation surgery and at 3 months follow-up. Results: There was no significant difference in the microvascular density within each annular zone and all quadrantal zones of the superficial and deep layers found in myopia patients before and after ICL surgery. Conclusion: Levels of microvascular density in retinal capillary plexuses were stable, as detected by the OCTA, showing the high security of ICL implantation, which would not leave adverse effects on retinal microvasculature in myopia patients.

Changes in chorioretinal flow index after cataract surgery: an optical coherence tomography angiography study

PURPOSE

Pseudophakic cystoid macular edema (CME) occurs in up to 2% of uneventful cataract surgeries. This study evaluates changes in macular blood flow succeeding uneventful phacoemulsification cataract extraction among otherwise visually healthy subjects.

METHODS

This prospective study included 18 eyes of 18 patients undergoing routine phacoemulsification. Optical coherence tomography angiography (OCT-A) was performed using the Angio-Retina 6 × 6 mm protocol with the XR Avanti Angio-Vue system (Optovue Inc., Fremont, California) prior to the surgery and 4-8 weeks thereafter. Exclusion criteria included motion artifacts, segmentation errors and signal strength index (SSI) < 40. The main outcome measure was change in flow index (FI) measured in all 4 retinal segmentation layers within an area of 1 mm diameter around the foveal center.

RESULTS

Following surgery, a significant increase in SSI (46.65 ± 8.62 versus 53.12 ± 8.07, p = 0.01), superficial plexus FI (0.98 ± 0.23 versus 1.16 ± 0.16, p = 0.02) and deep plexus FI (0.54 ± 0.46 versus 0.93 ± 0.39, p = 0.01) was found. No significant changes were noted in the outer retina or the choriocapillaris.

CONCLUSION

The study demonstrates a significant increase in FI in the superficial and deep retinal plexus following uneventful cataract surgery, with the greatest changes occurring in the latter. These findings corroborate evidence from structural imaging and support the vascular etiology of pseudophakic CME.

A prospective randomized clinical trial of active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract (AGSPC)

BACKGROUND

To figure out the efficacy, effects, safety and patient's subjective perceptions of phacoemulsification with the active-fluidics system (AFS).

PATIENTS AND METHODS

This was a prospective, randomized, double-masked, controlled clinical study. Age-related cataract patients were recruited and randomly assigned to the AFS group and gravity-fluidics system (GFS) group in a ratio of 1:1 to have phacoemulsification. Participants were followed up at one day, one week, one month and three months postoperatively (Chinese Clinical Trial Registry, ChiCTR2100044409).

RESULTS

The overall included participants were 107 finally. The total aspiration time of the AFS group was significantly less than that of the GFS group (p = .020), while no significant difference existed in cumulative dissipated energy and estimated fluid usage between the two groups. The best corrected visual acuity was significantly better in the AFS group at one day and one week postoperatively (p = .002, p = .038 respectively). The recovery of central corneal thickening and macular superficial vasculature increase was earlier in the AFS group. The central retinal thickness was significantly higher in the GFS group at one month and three months postoperatively (p = .029, p = .016 respectively). The incidence of corneal adverse events was higher in GFS group (p = .035). No serious adverse events occurred in either group. Pain scores and the scores of Cat-PROM5 questionnaire of the AFS group were significantly lower than that of the GFS group (p = .011, p = .002 respectively).

CONCLUSION

AFS improves the efficiency, effects, safety and patients' subjective perceptions of phacoemulsification compared with GFS. It is worthwhile to promote its application in cataract surgery.KEY MESSAGESThe active-fluidics system automatically detects and maintains stable intraocular pressure at the set value.The active-fluidics system improves the efficiency, effects, safety and patients' subjective perceptions in phacoemulsification.

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

The purpose of the study was to investigate the long-term effects of uncomplicated phacoemulsification on macular perfusion using optical coherence tomography angiography (OCTA) in healthy aging subjects. OCTA was performed before phacoemulsification and 1 week, 1 month, 3 months, and 6 months after. Superficial vascular complex (formed of nerve fiber layer vascular plexus and superficial vascular plexus), deep vascular complex (formed of intermediate capillary plexus and deep capillary plexus), as well as choriocapillaris (CC) and large choroidal blood vessels were recorded. Significant changes of vascular parameters in 95 eyes of 95 patients reached plateau 1 week after surgery and remained stable up to 6 months, occurring in all retinal layers but not in choroid and CC. Statistically significant increases in retinal vessels area, vessels percentage area, total number of junctions, junctions density, and total and average vessels length were found, followed by the total number of end points and mean lacunarity decline, proving an increase in blood supply. The study confirmed that uncomplicated phacoemulsification leads to a long-term increase in macular retinal perfusion. The results might ease the decision regarding timing for cataract surgery as long-term perfusion benefits can be achieved. Furthermore, study results provide a normative database of retinal and choroidal vasculature in healthy aging patients.

Hyper-reflective retinal foci as possible in vivo imaging biomarker of microglia activation in von Hippel-Lindau disease

Purpose

von Hippel-Lindau (VHL) disease is caused by a mutation of the VHL gene and characterized by the development of retinal hemangioblastomas (RH). Current pathophysiologic mechanisms of RH development and progression are still insufficient to predict RH behavior. VHL gene is involved in the cellular response to hypoxia and in many intracellular signaling pathways expressed both in angiogenesis and inflammation. Optical coherence tomography (OCT) allows to identify hyper-reflective retinal foci (HRF) known as aggregates of activated microglial cells as possible in vivo biomarker of local inflammation. The aim of the present study was to investigate the presence of HRF in patients with genetically confirmed VHL disease.

Methods

In this cross-sectional study, patients with VHL underwent complete ophthalmological examination and OCT with HRA + OCT Spectralis. HRF were manually identified and calculated in inner (IR), outer (OR) and full retina. Age-matched healthy subjects were enrolled as controls.

Results

113 eyes of 63 VHL patients and 56 eyes of 28 healthy subjects were evaluated. HRF number was significantly higher in VHL than in controls in IR (28.06 ± 7.50 vs 25.25 ± 6.64, p = 0.042). No difference was observed in OR and in full retina (OR: 7.73 ± 2.59 vs 7.95 ± 2.51, p = 0.599; full retina: 35.79 ± 8.77 vs 33.20 ± 7.47, p = 0.093).

Conclusion

The increase of HRF, which mirror retinal microglial activation, characterizes VHL eyes. The role of activated microglia in the retina of VHL eyes needs to be better investigated, mainly considering local VHL disease manifestations.

Long-Term Variations in Retinal Parameters after Uncomplicated Cataract Surgery

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.

Hyper-Reflecting Foci in Multiple Sclerosis Retina Associate With Macrophage/Microglia-Derived Cytokines in Cerebrospinal Fluid

Background

Increasing evidence suggests that retinal hyper-reflecting foci (HRF) might be clusters of activated and proliferating microglia. Since microglia are widespread activated in multiple sclerosis (MS) brain, its evaluation in retina may help to understand and monitor MS-related pathology.

Aim

This study aims at investigating the association of HRF with cerebrospinal fluid (CSF) cytokines and MRI parameters in relapsing–remitting MS (RRMS).

Methods

Nineteen RRMS at clinical onset and 15 non-inflammatory neurological disorders (NIND) underwent brain 3T MRI and CSF examination. Optical coherence tomography (OCT) analysis, including HRF count, was performed on RRMS patients. Sixty-nine cytokines/chemokines were analyzed in the CSF by multiplex technology.

Results

In RRMS, HRF count in the ganglion cell layer (GCL) was associated with IL-1Ra, IL-9, IL-15, IFN-γ, and G-CSF. Moreover, in RRMS patients CSF concentrations of IL-1Ra and G-CSF associated with global cortical thickness. The HRF count in the inner nuclear layer (INL) correlated with IL-22, IL-34, IL-35, CXCL-2, CXCL-10, and CXCL-13, and multivariate analysis confirmed a strong association (r²: 0.47) with both CXCL-2 (β: -0.965, p = 0.0052) and CXCL-13 (β: 0.241, p = 0.018). This latter cytokine increased in RRMS with high HRF count compared with NIND and RRMS with low HRF count. Finally, the CXCL-13/CXCL-2 ratio strongly associated with HRF count (r: 0.8, p < 0.005) and cortical lesion volume (r: 0.5, p < 0.05).

Conclusions

The association of HRF with intrathecally produced monocyte/microglia-derived cytokines confirms their microglial origin and indicates they are worth further evaluating as markers of activated microglia.

Evaluation of the effect of uncomplicated cataract surgery on retina and optic disc: Optical Coherence Tomography Angiography Study

Purpose

The aim of the present study is to evaluate the effects of uncomplicated cataract surgery on microvascular structure of fovea, parafovea, optic disc, and peripapillary area with optical coherence tomography angiography (OCTA).

Methods

The study included 53 eyes of 53 patients, who undergone uncomplicated cataract surgery. The day before cataract surgery and at the 1st week, 1st month, 3rd month after surgery, best-corrected visual acuity, foveal avascular zone, acircularity index, superficial and deep foveal density, superficial and deep parafoveal density, central macular thickness, peripapillary retinal nerve fiber layer thickness value, and peripapillary vascular density were measured with OCTA.

Results

The mean age of the patients was 62.1 ± 7.2 years (range, 42–69 years) and the sex of the patients was 25 male and 28 female. The foveal avascular zone value was decreased compared to the preoperative value (p < 0.05). There was no significant change in acircularity index postoperatively (p > 0.05). There was a significant increase in superficial and deep foveal density and superficial and deep parafoveal density (p < 0.05). According to preoperative period, peripapillary retinal nerve fiber layer and inside disc capillary density of optic disc increased significantly (p < 0.05). There was no significant change in peripapillary vascular density postoperatively (p > 0.05).

Conclusions

Changes in the vascular density of the retina were detected with OCTA in eyes without ocular or systemic disease, which underwent uncomplicated cataract surgery. In the postsurgical period, OCTA provides important information in the evaluation and follow-up of these changes.

RADIATION MACULOPATHY IS ANTICIPATED BY OCT HYPERREFLECTIVE RETINAL FOCI: A Large, Prospective, Confirmation Study

PURPOSE

To investigate, by means of spectral domain optical coherence tomography, retinal reflectivity changes as an early biomarker anticipating radiation-induced macular edema (ME) in patients treated by iodine-125 (I-125) brachytherapy.

METHODS

Thirty patients planned for I-125 brachytherapy because of uveal melanoma were prospectively included and followed every 4 months for five years. Reflectivity alterations, namely hyperreflective retinal foci, were characterized and counted by two independent masked examiners by means of spectral domain optical coherence tomography imaging. Hyperreflective retinal foci were defined as discrete intraretinal reflectivity changes ≤30 µm, with reflectivity similar to nerve fiber layer and without back shadowing.

RESULTS

Macular edema occurred in 17 patients (24.2 ±15.1 months) (group 1) after irradiation. Thirteen patients showed no signs of ME at the 5-year follow-up (group 2). The number of hyperreflective retinal foci was statistically higher in sequential visits until the evidence of ME in group 1 vs group 2 (P < 0.0001). In group 1, hyperreflective retinal foci at the follow-up before the evidence of ME were significantly related to the OCT central subfield thickness at ME appearance (P = 0.0002, r2=0.6129). The intergrader agreement was almost perfect (intraclass correlation coefficient = 0.80).

CONCLUSION

Hyperreflective retinal foci may be considered as an early in vivo imaging biomarker of retinal inflammatory response to ocular irradiation, anticipating the development of radiation maculopathy.

Retinal Glial Cells in Von Hippel-Lindau Disease: A Novel Approach in the Pathophysiology of Retinal Hemangioblastoma

Simple Summary

The in vivo optical coherence tomography analysis of the biomarkers of retinal microglia and macroglia in Von Hippel–Lindau disease represents an innovative field of research. The different behavior of these glial cells in Von Hippel–Lindau patients provides new data regarding the pathophysiology of retinal hemangioblastoma, the most common ocular manifestation of this hereditary disorder. Moreover, these biomarkers show a different behavior in Von Hippel–Lindau patients in relation to the presence or absence of retinal hemangioblastoma. Therefore, we can hypothesize that retinal hemangioblastoma is mainly due to the activation of macroglia by previously activated microglial cells.

Abstract

Background: Von Hippel–Lindau (VHL) disease is a neoplastic syndrome caused by a mutation of the VHL tumor suppressor gene. Retinal hemangioblastoma (RH) is a vascularized tumor and represents the most common ocular manifestation of this disease. At the retinal level, VHL protein is able to regulate tumor growth, angiogenic factors, and neuroinflammation, probably stimulating retinal glial cells. The aim of the present study was to analyze in vivo the optical coherence tomography (OCT) biomarkers of retinal macroglia and microglia in a cohort of VHL patients. Methods: The mean thicknesses of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and peripapillary retinal nerve fiber layer (pRNFL) were measured with OCT as biomarkers of retinal macroglia. OCT images were also analyzed to detect and quantify hyperreflective retinal foci (HRF), a biomarker of retinal activated microglia. Results: 61 eyes of 61 VHL patients (22 eyes (36.07%) with peripheral RH and 39 eyes (63.93%) without RH) and 28 eyes of 28 controls were evaluated. pRNFL was thinner in VHL patients (p < 0.05) and in VHL without RH (p < 0.01) compared to controls, and thicker in VHL patients with RH than in those without RH (p < 0.05). The thickness of mRNFL (p < 0.0001) and GCL (p < 0.05) was reduced in VHL patients and in VHL without RH compared to controls, whereas mRNFL (p < 0.0001) and GCL (p < 0.05) were increased in VHL patients with RH compared to those without RH. HRF were significantly higher in number in VHL patients and in VHL without RH, than in controls, and significantly lower (p < 0.05) in the eyes of VHL patients with RH, than in those without RH. Conclusions: The OCT analysis, which detects and allows to quantify the biomarkers of retinal microglia (HRF) and macroglia (pRNFL, mRNFL and GCL), showed a different behavior of these two retinal glial cells populations in VHL patients, related to the presence or absence of peripheral RH. These data allow to hypothesize a novel pathophysiologic pathway of retinal hemangioblastoma in VHL disease.

Decreased retinal microvasculature densities in pterygium

AIM

To investigate the retinal vascular network alterations in eyes of patients with pterygium.

METHODS

Totally 18 left eyes from 18 female pterygium patients and 18 left eyes from 18 female healthy control subjects were enrolled. Optical coherence tomography angiography (OCTA) images were generated of the superficial retinal layer and deeper retinal layer of the macular retina for each eye. The microvascular (MIR) and macrovascular (MAR) densities were calculated and MIR, MAR, and total microvascular (TMI) density was compared in the healthy control and pterygium groups.

RESULTS

In pterygium group, in the superficial retinal layer, the vascular density in superficial MIR, superior right (SR), inferior right (IR), right (R), superficial central annuli (SC)1, SC2, and SC3 decreased significantly in the macular area (P<0.05). Furthermore, the vascular density in all those decreased regions except R, was significantly and negatively correlated with the disease course (r=-0.6038 to -0.7762, P=0.0008), and the area size of pterygium (r=-0.6043 to -0.9508, P<0.05). For the deeper retinal layer, the density of deep total microvessel (DTMI), deeper MIR, SR, IR, R, DC2, and DC3 decreased significantly in macular area of pterygium patients (P<0.05). Furthermore, the vascular density in all those decreased regions was significantly and negatively correlated with the disease course (r=-0.6901 to -0.7795, P=0.0015), and the area size of pterygium (r=-0.6043 to -0.9563, P<0.05). No statistically significant differences and correlation was found in other region density (|r|<0.47, P>0.05).

CONCLUSION

OCTA findings suggest that pterygium patients present with decreased retinal MIR density, and the major vascular alterations occurr mainly on the bitamporal side. The vascular density of the superficial SC1, SC2, SC3 adjacent to the foveal and deep layer of DC2, DC2 regions, significantly decreased.

A Comparison of Hyper-Reflective Retinal Spot Counts in Optical Coherence Tomography Images from Glaucomatous and Healthy Eyes

Purpose: To compare the number of hyper-reflective retinal spots (HRS) in optical coherence tomography (OCT) images of healthy controls and patients affected with primary open angle glaucoma (POAG). Methods: Thirty patients affected with POAG and 34 healthy controls were recruited and underwent raster OCT examination of the macular region. Among the acquired B-scans, the one with the lowest foveal thickness was selected, and a central area of 3000 μm was defined (region of interest, ROI), in order to identify HRS. HRS were defined as small point-like hyper-reflective elements, detectable at the visual inspection of the OCT image. HRS were independently counted by two investigators in the ROI of each OCT scan. Results: Inter-rater agreement for HRS counting was good to excellent (ICC = 0.96, 95% CI: 0.83–0.99). More HRS were found in the OCT images from glaucoma patients, in comparison with healthy controls (average value: 90.5 ± 13.02 and 74.72 ± 11.35, for glaucoma and healthy subjects, respectively; p < 0.01). Significant correlations between the average number of HRS and visual field mean deviation (MD, p = 0.01) and pattern standard deviation (PSD, p < 0.01) were found. Conclusions: OCT images from glaucoma patients showed a higher number of HRS when compared with healthy controls. As HRS have been hypothesized to be a sign of neuroinflammation, these results may support the role of neuroinflammation in glaucoma etiopathogenesis.

The effect of phacoemulsification performed with vitrectomy on choroidal vascularity index in eyes with vitreomacular diseases

This study evaluated the effects of cataract surgery combined with pars plana vitrectomy (ppV) on choroidal vascularity index (CVI) in eyes with epiretinal membrane (ERM) and full thickness macular hole (FTMH). Medical records of 132 eyes with ERM or FTMH were retrospectively reviewed and classified into a ppV group and a ppV combined with cataract surgery group (phaco + ppV group). The CVI were measured at baseline, 1, 3 and 6 months after the surgery, using the selected swept-source (SS) optical coherence tomography (OCT) scan passing through the central fovea, which was then segmented into luminal and stromal area by image binarization. The mean CVI of phaco + ppV group were 61.25 ± 1.97%, 61.66 ± 1.81%, and 62.30 ± 1.92% at baseline, 1 and 3 months, respectively (p < 0.001). The mean CVI of ppV group were 62.69 ± 1.92%, 62.03 ± 1.51%, and 61.45 ± 1.71% at baseline, 1 and 3 months, respectively (p < 0.001). The final CVI were measured at 6 months and compared with the baseline CVI. The mean CVI of phaco + ppV group were 61.21 ± 1.99% at baseline and 60.68 ± 2.02% at 6 months (p < 0.001). The mean CVI of ppV group were 62.93 ± 1.70% at baseline and 61.77 ± 1.74% at 6 months (p < 0.001). Vitrectomy significantly decreases CVI in vitreomacular diseases possibly due to the removal of vitreomacular traction or postoperative oxygenation change in the eye. On the contrary, combined surgery of vitrectomy and cataract surgery significantly increases CVI in the early stage of postoperative period, which suggests choroidal vascular dilatation or congestion due to postoperative inflammation. Although the CVI were measured lower than the baseline in the end, more thorough inflammation control may be essential after combined surgery.

OCT Hyperreflective Retinal Foci in Diabetic Retinopathy: A Semi-Automatic Detection Comparative Study

Optical coherence tomography (OCT) allows us to identify, into retinal layers, new morphological entities, which can be considered clinical biomarkers of retinal diseases. According to the literature, solitary, small (<30 µm), medium level hyperreflective (similar to retinal fiber layer) retinal foci (HRF) may represent aggregates of activated microglial cells and an in vivo biomarker of retinal inflammation. The identification and quantification of this imaging biomarker allows for estimating the level and possibly the amount of intraretinal inflammation in major degenerative retinal disorders, whose inflammatory component has already been demonstrated (diabetic retinopathy, age-related macular degeneration, radiation retinopathy). Currently, diabetic retinopathy (DR) probably represents the best clinical model to apply this analysis in the definition of this clinical biomarker. However, the main limitation to the clinical use of HRF is related to the technical difficulty of counting them: a time-consuming methodology, which also needs trained examiners. To contribute to solve this limitation, we developed and validated a new method for the semi-automatic detection of HRF in OCT scans. OCT scans of patients affected by DR, were analyzed. HRF were manually counted in High Resolution spectral domain OCT images. Then, the same OCT scans underwent semi-automatic HRF counting, using an ImageJ software with four different settings profiles. Statistical analysis showed an excellent intraclass correlation coefficient (ICC) between the manual count and each of the four semi-automated methods. The use of the second setting profile allows to obtain at the Bland–Altman graph a bias of −0.2 foci and a limit of agreement of ±16.3 foci. This validation approach opens the way not only to the reliable and daily clinical applicable quantification of HRF, but also to a better knowledge of the inflammatory component—including its progression and regression changes—of diabetic retinopathy.

Macular Vascular Density Changes following Cataract Surgery in Diabetic Patients: An Optical Coherence Tomography Angiography Study

Purpose

Cataracts and diabetes very commonly coexist. The aim of the present study was to quantify the effect of uncomplicated phacoemulsification on retinal microvasculature in diabetic patients by using optical coherence tomography angiography (OCTA).

Methods

A prospective observational study of diabetic and nondiabetic patients at baseline and 1 day, 1 week, 1 month, and 3 months after cataract surgery was performed by using OCTA. We measured the macular thickness (MT), superficial capillary plexus (SCP), deep capillary plexuses (DCP), and foveal avascular zone (FAZ) in the 3 × 3 mm macular images.

Results

A total of 32 eyes of 32 type 2 diabetic patients and 40 eyes of 40 nondiabetic patients were assessed. There was a significant increase in MT at 1 month and 3 months after surgery in both groups (all P < 0.05), but there was no significant difference between the two groups (P=0.217). At 3 months postoperatively, the SCP level in the diabetic group was significantly higher than that at baseline (P < 0.05). The MT and SCP were negatively correlated with logMAR best-corrected visual acuity (BCVA), while the FAZ area and perimeter were positively correlated with logMAR BCVA in the diabetic group.

Conclusions

Our study demonstrated that phacoemulsification can increase macular thickness in both diabetic and nondiabetic patients and increase SCP in diabetic patients within 3 months after surgery. Whether these changes persist for a longer period still needs to be investigated.

Early changes in retinal microcirculation after uncomplicated cataract surgery using an active-fluidics system

PURPOSE

To evaluate the early changes in retinal microcirculation after uncomplicated cataract surgery using an active-fluidics system.

MATERIALS AND METHODS

Patients underwent uncomplicated cataract surgery for both eyes were enrolled. The two eyes of the patients were randomly assigned to two groups, the active-fluidics group and the gravity-fluidics group. One eye using an active-fluidics system, and the other using a gravity-fluidics system. Optical coherence tomography angiography (OCTA) was performed at 1 day, 7 days, 30 days, and 90 days after surgery.

RESULTS

Fifty eyes (25 patients) were included in the final analysis. A significantly lower cumulative dissipated energy (CDE), estimated fluid usage (EFU), and total aspiration time (TAT) were observed in the active-fluidics group (all P<0.05). The superficial vessel density at parafoveal region increased at 7 days and 30 days after cataract surgery in the eyes of both the active-fluidics and gravity-fluidics groups, with the fluctuation in eyes of the gravity-fluidics group more significant. The vessel density of deep capillary plexus remained stable during the follow-up period. Significant changes of retinal thickness in macular region (fovea, parafovea) were observed in eyes of the gravity-fluidics group through the comparison of corresponding values at different time points (p = 0.008, 0.005). No significant change in retinal thickness was observed in eyes of the active-fluidics.

CONCLUSIONS

Retinal microcirculation and thickness were disturbed after cataract surgery using the gravity-fluidics infusion system. The active-fluidics system not only improved the surgical efficacy but also protected the retinal vasculature during cataract surgery.

CLINICAL TRIALS REGISTRATION

The study has been registered at www.clinicaltrials.gov with its clinical trial accession number of NCT0130500.

Macular perfusion analysed by optical coherence tomography angiography after uncomplicated phacoemulsification: benefits beyond restoring vision

Background

The purpose of the study is to investigate the changes of macular perfusion by OCT-angiography (OCT-A) after uncomplicated phacoemulsification.

Methods

OCT-A was performed before cataract surgery, 1 week, 1 month, and 3 months after surgery recording superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), as well as large choroidal blood vessels and choriocapillaris (CC). Explant area (EA), vessels area (VA), vessels percentage area (VPA), total number of junctions (TNJ), junctions density (JD), total vessels length (TVL), average vessels length (AVL), total number of end points (TNEP), and mean lacunarity (ML) throughout all layers were analysed.

Results

Significant changes of vascular parameters in 55 eyes of 55 patients mostly reached plateau one week after surgery and remained stable up to 3 m after surgery, occurring in all retinal layers but not in choroid and CC. The greatest increase in VPA (22.79%), TVL (16.71%), AVL (166.71%) and JD (29.49%) was in SVC. On the contrary, the greatest change of ML (− 53.41%) appeared in DVC.

Conclusions

This is the first OCT-A study demonstrating perfusion alterations in macula after phacoemulsification due to functional hyperaemia. We presume the effect is evoked by increased light intensity stimulation of retina after cataract removal. Accordingly, phacoemulsification in elderly population could have advantageous feature in addition to restoring visual acuity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-01837-2.

Effects of Femtosecond Laser-Assisted Cataract Surgery on Macular and Choroidal Thickness in Diabetic Patients

Introduction

This study aimed to compare the short-term changes in retinal and choroid thickness in diabetic patients after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (PE) surgery.

Methods

A total of 47 eyes in the PE group and 44 eyes in the FLACS group were included. All patients underwent measurement of central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) before and after surgery using optical coherence tomography (OCT).

Results

The effective phaco time (EPT) in the FLACS group was significantly reduced. The BCVA differed significantly between the two groups at 1 week and 1 month after surgery. The CMT in both groups increased at 1 week after the operation. It did not return to the preoperative level until month 12 in the PE group. In the FLACS group, the CMT began to decrease at month 3 and recovered to the preoperative level at month 12. The SFCT of the two groups increased at week 1; it began to decrease at month 6 in the PE group but did not recover to the preoperative level until month 12. The SFCT in the FLACS group recovered to preoperative levels at month 6. In the PE group, baseline CMT values predicted CMT change at week 1 and months 1, 3 and 12 after surgery. In the FLACS group, baseline CMT predicted CMT changes at week 1, month 1 and month 3. In the FLACS group, EPT predicted SFCT change at month 3.

Conclusion

FLACS is safe and effective in patients with no fundus change or mild diabetic retinopathy. It has advantages in effectively reducing EPT, achieving good vision earlier and promoting faster recovery of the retinal and choroidal thickness. Preoperative CMT is a significant predictor of CMT changes in the early period after FLACS.

Analysis of macular microvasculature and thickness after ICL implantation in patients with myopia using optical coherence tomography

AIM

To investigate changes in macular vessels and thickness in myopic eyes after intraocular collamer lens (ICL) implantation using quantitative optical coherence tomography angiography (OCTA).

METHODS

This retrospective included 73 myopic eyes of 73 patients (average age, 27.53±6.16y) who underwent ICL implantation (28 eyes were Toric ICL). Axial length (AL), uncorrected visual acuity (UCVA), refractive dioptre (RD), intraocular pressure (IOP) and OCTA were measured and compared with before and 1wk, 1, and 3mo after surgery. OCTA was used to image vessel density (VD) and skeleton density (SD) in both the superficial (SCP) and deep capillary plexus (DCP). Central retinal thickness (CRT) and ganglion cell-inner plexiform layer thickness (GCT) were also measured. Changes between pre- and postoperative measurements were analysed by repeated measures analysis of variance.

RESULTS

Compared with preoperative data, postoperative data on UCVA revealed significant improvements in all patients (P<0.05). However, there was no significant difference in IOP. After the operation, CRT and GCT exhibited significant changes (P<0.05). Among these measures, CRT was significantly higher at one and three months postoperative (all P<0.01). GCT was significantly higher at 1wk, 1, and 3mo postoperative (all P<0.01). Changes in VD and SD were nonsignificant in both the SCP and DCP. There was no difference in postoperative changes between the ICL and Toric ICL groups.

CONCLUSION

ICL and Toric ICL implantation both have good efficacy and safety for myopic eyes, but macular area changes that occur after surgery need attention.

Early Retinal Changes by OCT Angiography and Multifocal Electroretinography in Diabetes

Background: To evaluate the earliest retinal morphological and functional changes in diabetic eyes without or with early signs of diabetic retinopathy (DR). Methods: Twenty-two eyes with no DR (noDR group), 22 eyes with mild DR (DR group), and 18 healthy nondiabetic eyes (controls) were enrolled. All eyes were studied by means of spectral domain optical coherence tomography (OCT), OCT angiography (OCTA), and multifocal electroretinogram (mfERG). Results: A significantly higher number of OCT hyperreflective intraretinal foci (HRF) was found in both noDR and DR groups versus controls, but not between DR groups. The OCTA parameters of the superficial vascular plexus (SVP) were significantly reduced in the noDR group both versus controls and DR group (p < 0.05). The OCTA parameters of the intermediate capillary plexus (ICP) were significantly reduced in the DR group versus controls. An increased number of altered hexagons on mfERG was found in the noDR versus the DR group (p = 0.0192). Conclusions: Retinal vascular and functional parameters are differently involved in diabetic eyes; major vascular changes in the SVP and functional alterations of the mfERG are present in diabetic eyes with no clinical microvascular signs of DR, while ICP is mainly involved when early ophthalmoscopic signs of DR are present. The integrated use of mfERG and OCTA provides new significant insights into the pathogenesis of diabetic related retinal disease.

Examination of retinal vascular density changes via optical coherence tomography angiography in patients with glaucoma

PURPOSE

The aim of this study was to investigate the changes in vessel density (VD) in glaucoma patients and to investigate the relationship between VD and structural parameters using optical coherence tomography angiography.

METHODS

Our study included 25 primary open-angle glaucoma (POAG) patients, 25 pseudoexfoliation glaucoma (PXG) patients and 25 healthy individuals. All patients underwent 6 × 6 mm retinal angiography (upper limit: internal limitan membrane [ILM], lower limit: 10 µm inferior to inner plexiform layer) and 4.5 × 4.5 mm disk angiography (upper limit: ILM, lower limit: posterior border of the retinal nerve fiber layer [RNFL]) via an optical coherence tomography (OCT) system (AngioVue, Optovue). Measures of vascular density were as follows: total area VD (tVD), intrapapillary VD (iVD), peripapillary VD (pVD) and parafoveal VD (pfVD). In addition to performing comparisons, the correlations between pVD, retinal nerve fiber layer (RNFL) thickness and optic nerve head measurement results were investigated.

RESULTS

A total of 75 individuals were included in our study. In the POAG and PXG groups, tVD and pVD values were significantly lower than the control group (median tVDs were: 45.4, 45.9, 50.0, and median pVDs were: 50.0, 50.3, 53.1, respectively) (confidence intervals were: - 9.8/- 1.1 for pVD and - 8.6/- 1.4 for tVD). Significantly lower pf-VD values were detected in the PXG group compared to the control group (p < 0.05). There were strong positive correlations between RNFL thickness and pVD in in glaucoma groups (p < 0.001). There was no correlation between pVD and disk area, intraocular pressure and age in glaucoma patients. Patients using beta-blockers had significantly lower tVD and pVD values compared to those who did not (p < 0.05).

CONCLUSION

The low VD values in glaucomatous eyes and the strong correlations between that values and RNFL thickness demonstrate a relationship between structural parameters and vascular parameters.

Transient reduction in macular deep capillary density on optical coherence tomography angiography after phacoemulsification surgery in diabetic patients

Background

To evaluate macular microvascular changes and associated factors in diabetic patients following uncomplicated phacoemulsification surgery.

Methods

In this prospective observational study, we enrolled diabetic patients and non-diabetic controls who underwent phacoemulsification surgery. Participants were examined at postoperative day 1 (POD1), 10 (POD10), 30 (POD30), and 90 (POD90), using macular 3x3mm OCT angiography scan (RTVue-XR Avanti; Optovue, Inc., Fremont, CA). Integrated automated algorithms were used to quantify parafoveal vessel density (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP). To minimize measurement bias, subjects with corneal edema or capsular opacity at any postoperative visit were excluded.

Results

The study included 21 eyes of 21 diabetic patients and 21 eyes of 21 non-diabetic controls. In diabetic patients, no significant change in SCP-VD could be detected (P = 0.57); DCP-VD reduced from 50.24 ± 2.33% at POD1 to 48.33 ± 3.07% at POD30 (P = 0.019), and restored to 50.74 ± 3.44% at POD90 (P = 1.00). The DCP-VD change at POD30 in diabetic patients (− 1.90 ± 2.61%) was significantly different from that in controls (1.31 ± 2.61%) (P < 0.001). The amount of DCP-VD reduction was correlated with foveal and parafoveal thickening (r = 0.431, P = 0.051 and r = 0.514, P = 0.017, respectively), high cumulative dissipated energy (P = 0.032) and increased hemoglobin A1c concentration (P = 0.037).

Conclusions

Phacoemulsification in diabetic patients caused transient reduction in DCP-VD, which was associated with poor glycemic control, surgical trauma, and postoperative macular thickening. Our results added a new dimension to our understanding of the complex biologic effects of cataract surgery in diabetic subjects.

Evaluation of choroidal thickness, macular thickness, and aqueous flare after cataract surgery in patients with and without diabetes: a prospective randomized study

BACKGROUND

In diabetic eyes, various choroidal abnormalities are noted in addition to changes in the retinal circulation, and the risk of increased aqueous flare and retinal thickening after cataract surgery is higher in diabetic eyes. Inflammation caused by surgery induces breakdown of the blood-retinal barrier and affects the retina, although the influence on the choroid is unknown. Several researchers have evaluated the choroidal thickness (CT) after cataract surgery in patients with diabetes; however, the results are inconsistent. The purpose of this study was to evaluate the influence of uneventful small-incision phacoemulsification cataract surgery on the subfoveal choroidal thickness (SCT), the central macular thickness (CMT), and aqueous flare in patients with diabetes.

METHODS

This study included 59 randomly selected eyes (33 eyes of patients with diabetes and 26 eyes of control patients without diabetes) undergoing small-incision cataract surgery. Among the diabetic eyes, 26 were without diabetic retinopathy, and the remaining eyes had non-proliferative diabetic retinopathy. Aqueous flare, CMT, and SCT measurements were performed before and at 1 week, 1 month, and 3 months after surgery.

RESULTS

The postoperative CMT continued to increase significantly until 3 months in both groups. Although the CMT was more in patients with diabetes than in patients without diabetes during the follow-up period, there was no significant difference between the two groups. The aqueous flare value increased until 3 months after surgery in both groups. Although the increase was significant at 3 months after surgery in patients with diabetes, the increase in controls was not significant. The aqueous flare values differed significantly between the two groups before and at 3 months after surgery. There was no significant within-group or between-group difference in pre- and postoperative SCT values.

CONCLUSION

In diabetic eyes with early stage of retinopathy, even small-incision cataract surgery can induce increased aqueous flare and macular thickening until 3 months, although there is no significant change in the choroidal thickness. Further studies are essential to evaluate choroidal changes after the cataract surgery in diabetic eyes.