Use of ellipsoid zone width for predicting visual prognosis after cataract surgery in patients with retinitis pigmentosa

Abstract

Objective: To predict the visual prognosis of cataract surgery in patients with retinitis pigmentosa by measuring ellipsoid zone (EZ) width using spectral-domain optical coherence tomography.

Methods: This retrospective study included patients with retinitis pigmentosa who underwent uncomplicated cataract surgery between December 2017 and June 2020. Preoperative best-corrected visual acuity (BCVA) and the best postoperative BCVA during follow-up were collected. EZ width was measured on preoperative cross-sectional optical coherence tomography images along the horizontal/vertical meridian through the fovea.

Results: Thirty-eight eyes of 38 patients (22 female; mean [±standard deviation] age, 62.1 ± 11.8 years) were included. The median preoperative logarithm of the minimum angle of resolution BCVA of 0.52 (range, 0.00-3.00) significantly improved to 0.07 (range, -0.18-3.00) after surgery (P < 0.001). On preoperative spectral-domain optical coherence tomography images, the median horizontal, vertical, and average EZ widths were 783 (range, 0-9837), 761 (range, 0-10 250), and 769 (range, 0-10 043) μm, respectively. Postoperative BCVA significantly correlated with the horizontal (r = -0.784, P < 0.001), vertical (r = -0.777, P < 0.001), and average EZ widths (r = -0.777, P < 0.001). The area under the receiver operating characteristic curve for the ability of the horizontal, vertical, and average EZ widths to discriminate eyes with and without postoperative BCVA ≤ 0.3 was 0.971, 0.960, and 0.963, respectively, with best cut-off values of 513, 608, and 515 μm, respectively.

Conclusions: EZ width measurement can help predict the visual prognosis of cataract surgery in patients with retinitis pigmentosa. A preferable visual acuity prognosis can be expected in patients with an EZ width of approximately 600 μm.

Fig. 1

Distributions of the horizontal, vertical, and average ellipsoid zone (EZ) widths.

Fig. 2. Scatter plots showing the relationships between preoperative measurements and postoperative logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA).

a Relationship between the horizontal ellipsoid zone (EZ) width and postoperative logMAR BCVA. b Relationship between the vertical EZ width and postoperative logMAR BCVA. c Relationship between the average EZ width and postoperative logMAR BCVA. d Relationship between preoperative and postoperative logMAR BCVA.

Fig. 3

Receiver operating characteristic curves of the horizontal, vertical, and average ellipsoid zone (EZ) widths and preoperative logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA).