The effects of phacoemulsification and scleral-fixated intraocular lens implantation on the choroidal vascular index: A comparative study

Abstract

This study evaluates and compares choroidal vascular changes in patients undergoing phacoemulsification and scleral-fixated intraocular lens implantation. The research focused on assessing the choroidal vascular index (CVI) and choroidal thickness as indicators of vascular and structural integrity, using normal eyes as controls. This comparative study involved 135 eyes divided into 3 groups, phacoemulsification, scleral-fixated intraocular lens implantation, and control. Choroidal thickness and CVI were evaluated using optical coherence tomography within the first 3 months after surgery. Image binarization with ImageJ was used to calculate the luminal area, total choroidal area, and vascular index. No significant differences were determined in foveal choroidal thickness (P = .208; 274.48 ± 50.37 μm, 265.13 ± 41.68 μm, and 284.18 ± 58.69 μm for control, phacoemulsification, and scleral fixation groups, respectively) or temporal choroidal thickness (P = .243; 272.87 ± 51.37 μm, 267.71 ± 40.38 μm, and 284.60 ± 53.04 μm, respectively). However, nasal choroidal thicknesses differed between the groups (P < .05; 275.00 ± 45.13 μm, 261.53 ± 33.95 μm, and 285.14 ± 60.16 μm), with a significant difference between the phacoemulsification and scleral fixation groups (P = .024). Vascular parameters, including luminal area (P = .081), total subfoveal choroidal area (P = .070), and the CVI (P = .173), exhibited no statistically significant differences. While overall choroidal integrity remains preserved post-surgery, regional changes, particularly in the nasal choroid, suggest a localized hemodynamic response affected by surgical manipulation and inflammation. These findings highlight the importance of monitoring choroidal changes to improve postoperative management.

Keywords: choroidal vascular index; optical coherence tomography; phacoemulsification; postoperative outcomes; scleral-fixated intraocular lens.

Figure 1.

Choroidal thickness measurements were obtained using optical coherence tomography (EDI-OCT) following phacoemulsification surgery.

Figure 2.

Image binarization of the choroid in a patient with scleral-fixated intraocular lens implantation at 1 month postoperatively. Choroidal vascularity index (CVI); the image color was rendered black and white using the Niblack binarization technique. The subfoveal choroidal vascular and stromal structure was selected automatically selected and calculated using ImageJ software.