Change in Subfoveal Choroidal Thickness following Cataract Surgery Imaged with Enhanced Depth Imaging Optical Coherence Tomography

Abstract

Background Due to its invasive nature, cataract surgery can lead to inflammatory processes in the posterior segment, which can result in prolonged recovery times, reduced functional outcomes, and late-onset complications. The aim of the current study was to identify wherever phacoemulsification parameters play a role in choroidal thickness change following cataract surgery.

Methods This prospective single-center study enrolled 31 patients (31 eyes) scheduled to undergo routine cataract surgery. Patients with previous ocular surgeries, pathologies or general disorders affecting vision were excluded. Patients were examined preoperatively, as well as 1, 4, and 12 weeks after surgery. Corrected distance visual acuity (CDVA), intraocular pressure (IOP) as well as cumulative dissipated energy (CDE), ultrasound time (UT), and fluids used during surgery were recorded. Subfoveal choroidal thickness was measured manually by two masked independent experts using enhanced depth imaging (EDI) optical coherence tomography (OCT). Furthermore, cataract density was automatically calculated using a custom MATLAB script and an anterior segment OCT.

Results Subfoveal choroidal thickness increased significantly (p < 0.001, Studentʼs paired sample t-test) and continuously during the 12-week-long follow-up period. Both the nuclear lens density and the improvement in CDVA correlated significantly with this increase (r = 0.413, p = 0.021 and r = 0.421, p = 0.018, respectively). Neither the CDE (r = 0.334, p = 0.071), the UT (r = 0.102, p = 0.629), the amount of fluid used (r = 0.237, p = 0.27) nor the decrease in IOP (r = − 0.197, p = 0.288) showed any significant correlation with the choroidal swelling.

Conclusion Cataract surgery leads to an increase in subfoveal choroidal thickness. While no statistically significant correlation to the phacoemulsification parameters could be established, this might be because of a selection bias due to the technological constraints of the OCT. Nevertheless, the choroid might play a central role in early- and late-onset complications.

Zusammenfassung

Hintergrund Wie jeder invasive Eingriff führt die Kataraktoperation zu einer Freisetzung von inflammatorischen Mediatoren in den hinteren Augenabschnitt, welche die Genesungszeit verlängern, das funktionelle Ergebnis verschlechtern und zu Spätkomplikationen führen können. Das Ziel dieser Studie ist herauszufinden, inwiefern die Phakoemulsifikationsparameter einen Einfluss auf die Dicke der Choroidea nach der Kataraktoperation ausüben.

Methoden In dieser prospektiven Single-Center-Studie wurden 31 Patienten (31 Augen), die sich zur Kataraktoperation vorstellten, eingeschlossen. Ausgeschlossen wurden Patienten mit vorherigen Augenoperationen, Pathologien oder Allgemeinerkrankungen, die das Sehen beeinträchtigen. Jeder Patient wurde vor der Operation sowie 1, 4 und 12 Wochen postoperativ untersucht. Der Fernvisus, der Intraokulardruck sowie die Phakoemulsifikationsenergie, die Ultraschallzeit und der Flüssigkeitsverbrauch während der Operation wurden festgehalten. Die Dicke der Choroidea wurde manuell von 2 verblindeten unabhängigen Experten mittels Enhanced Depth Imaging (EDI) optischer Kohärenztomografie (OCT) gemessen. Zudem wurde die Kataraktdichte automatisch anhand eines Vorderabschnitts-OCT und eines MATLAB-Skripts berechnet.

Ergebnisse Die subfoveale Choroiddicke hat stetig und signifikant (p < 0,001 mittels t-Differenztest) während der 12 Wochen langen Nachbeobachtungszeit zugenommen. Sowohl die Dichte des Linsenkerns als auch der Fernvisus zeigten eine signifikante Korrelation zur Dickenzunahme (r = 0,413; p = 0,021 und r = 0,421; p = 0,018). Weder die Phakoemulsifikationsenergie (r = 0,334; p = 0,071) noch die Ultraschallzeit (r = 0,102; p = 0,629), der Flüssigkeitsverbrauch (r = 0,237; p = 0,27) oder die Verringerung des IOD (r = − 0,197; p = 0,288) zeigten eine signifikante Korrelation zur choroidalen Dickenzunahme.

Schlussfolgerung Die Kataraktoperation führt zu einer Zunahme der subfovealen Choroiddicke. Zwar konnten keine statistisch signifikanten Korrelationen zu den Phakoemulsifikationsparametern festgestellt werden, da es möglicherweise zu einem Selektionsbias aufgrund der Einschränkungen der OCT-Technologie kam, jedoch könnte die Choroidea dennoch eine zentrale Rolle sowohl bei Früh- als auch bei Spätkomplikationen spielen.

Conclusion Box

Already known:

• Cataract surgery leads to an increase in central choroidal thickness.

• The precise reason for this increase has yet to be elucidated. This study aimed to uncover whether surgical and functional parameters play a role in postoperative choroidal swelling.

Newly described:

• The nuclear lens density correlated significantly with the postoperative choroidal thickness increase.

• No significant correlation was established with the surgical metrics. This might be due to our small and homogenous study population.

Key words

cataract - choroid - cataract surgery - phacoemulsification - optical coherence tomography - enhanced depth imaging

Schlüsselwörter

Choroidea - Katarakt - Kataraktoperation - Phakoemulsifikation - optische Kohärenztomografie - Enhanced Depth Imaging

Publication History

Received: 24 January 2023

Accepted: 12 June 2023

Article published online:
11 August 2023

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