Changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography

Abstract

Aim: To assess the changes in the peripapillary vasculature and macular thickness after cataract surgery using two phacoemulsification systems with optical coherence tomography angiography (OCTA).

Methods: Fifty-two eyes of 52 patients with age-related cataract were randomized into two groups for phacoemulsification: Infiniti group (26 patients) using the Infiniti phacoemulsification system with gravity-fluidics and Centurion group (26 patients) using the Centurion phacoemulsification system with active-fluidics. The peripapillary vessel density (PVD) and macular thickness were examined using OCTA at baseline and at 1d, 1 and 3mo after cataract surgery.

Results: In the Infiniti group, the PVD was significantly reduced at 1d after the cataract surgery (P<0.001). However, the retinal nerve fiber layer (RNFL) thickness showed no significant change during the follow-up. Change in PVD 1d postoperatively was significantly negatively correlated to the cumulative dissipated energy (CDE), estimated fluid usage (EFU), effective phacoemulsification time (EPT), intraocular pressure (IOP), and total operating time (TOT; P<0.05). The macular thickness was significantly increased in all regions after the cataract surgery (P<0.05). However, no significant changes were found in the macular vessel density (VD) during the follow-up (P>0.05). In the Centurion group, the VD and thickness in the optic papilla and macula did not significantly change in all regions during the follow-up (all P>0.05). The best-corrected visual acuity (BCVA) significantly improved in both groups postoperatively (P<0.001).

Conclusion: Using the Infiniti phacoemulsification system, OCTA provides a promising analysis of retinal vascular alterations, demonstrating a reduction of the PVD and an increase in the macular thickness. The Centurion phacoemulsification system can provide better retinal vasculature preservation during cataract surgery.

Keywords: cataract surgery; optical coherence tomography angiography; phacoemulsification system; retinal vasculature.

Figure 1. A 4.5×4.5-mm² image of optic disc angiogram.

Figure 2. A 3×3-mm² image of superficial capillary plexus angiogram.

Figure 3. The IOP, EPT, EFU, CDE and TOT are negatively correlated with the change in PVD at 1d postoperatively

IOP: Intraocular pressure; EPT: Effective phacoemulsification time; EFU: Estimated fluid usage; CDE: Cumulative dissipated energy; TOT: Total operating time; PVD: Peripapillary vessel density.