Comparison of Vascular Density Changes After Cataract Surgery in Diabetic Patients with and Without Pseudoexfoliation Syndrome Using Optical Coherence Tomography Angiography

Abstract

Background: This study aims to evaluate changes in the central retina in patients with type 2 diabetes mellitus (T2DM) undergoing uncomplicated small incision cataract surgery with or without pseudoexfoliation syndrome (PEXS) using optical coherence tomography angiography (OCTA). Methods: In this prospective, longitudinal study, 67 T2DM patients underwent cataract surgery. Twelve of them had PEXS. All parameters were measured at two time points. Macular 3 × 3 mm and 6 × 6 mm OCTA images were obtained. All data were analyzed using R statistical software (version 4.4.1). Results: Parafoveal vascular density (VD) in the superior capillary plexus and the deep capillary plexus increased in the non-PEX group. There was an increase in VD in perifoveal vascular density in the deep capillary plexus in both groups. Three months after cataract surgery, changes in perifoveal vascular density in the deep capillary plexus increased in both groups and were significant. Conclusion: Perifoveal vascular density in the deep capillary plexus showed a significant increase in VD, regardless of the presence of PEXS. Parafoveal VD in the deep and superficial capillary plexuses appeared to be sensitive primarily in non-PEXS patients, with a notable increase observed in these areas three months after surgery.

Keywords: diabetic retinopathy; optical coherence tomography angiography; phacoemulsification cataract surgery; pseudoexfoliation syndrome; type 2 diabetes mellitus; vascular density.

Figure 4

Within-group comparison of CRT. (A) Non-PEX; (B) PEX; and (C) all before and after values. Means (blue dots) and medians (middle line on box plots) in (A) non-PEX, (B) PEX, and (C) all before and after values.

Figure 5

Within-group comparison of PER DCP. (A) Non-PEX; (B) PEX; and (C) all before and after values. Means (blue dots) and medians (middle line on box plots) in (A) non-PEX, (B) PEX, and (C) all before and after values.

Figure 1

Histogram of age by gender. 1—women; 2—men.

Figure 2

BCVA comparisons between groups. BCVA initial value distribution comparison between PEX and non-PEX subjects (A), follow-up BCVA value distribution comparison between patients with and without PEX (B) as well as before–after BCVA value scatter plot grouped by PEX (C). Means (blue dots) and medians (middle line on box plots) in plots (A,B) for initial and follow-up measurements. Abbreviations: PEX, pseudoexfoliation; BCVA, best-corrected visual acuity.

Figure 3

Within-group comparison of BCVA. Means (blue dots) and medians (middle line on box plots) in (A) non-PEX; (B) PEX; and (C) all before and after values.