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

• References

• 1 Welsch U, Kummer W, Deller T. Lehrbuch Histologie. Amsterdam: Elsevier Health Sciences; 2022
• 2 Grossniklaus HE, Green WR. Choroidal neovascularization. Am J Ophthalmol 2004; 137: 496-503
• 3 Iida T, Kishi S, Hagimura N. et al. Persistent and bilateral choroidal vascular abnormalities in central serous chorioretinopathy. Retina 1999; 19: 508-512
• 4 World Health Organization (WHO). World report on vision. Geneva: World Health Organization; 2019. Accessed July 05, 2023 at: https://www.who.int/publications/i/item/9789241516570
• 5 Pande MV, Spalton DJ, Kerr-Muir MG. et al. Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: aqueous flare and cells. J Cataract Refract Surg 1996; 22: 770-774
• 6 Miyake K, Ibaraki N. Prostaglandins and cystoid macular edema. Surv Ophthalmol 2002; 47 (Suppl. 01) S203-S218
• 7 Ho JD, Xirasagar S, Kao LT. et al. Neovascular age-related macular degeneration is associated with cataract surgery. Acta Ophthalmol 2018; 96: e213-e217
• 8 Ehmann DS, Ho AC. Cataract surgery and age-related macular degeneration. Curr Opin Ophthalmol 2017; 28: 58-62
• 9 Ohsugi H, Ikuno Y, Ohara Z. et al. Changes in choroidal thickness after cataract surgery. J Cataract Refract Surg 2014; 40: 184-191
• 10 Aumann S, Donner S, Fischer J. et al. Optical coherence tomography (OCT): principle and technical realization. In: Bille J. ed. High Resolution Imaging in Microscopy and Ophthalmology. Cham: Springer; 2019: 59-85
• 11 Mackenbrock LHB, Łabuz G, Yildirim TM. et al. Automatic Quantitative Assessment of Lens Opacities Using Two Anterior Segment Imaging Techniques: Correlation with Functional and Surgical Metrics. Diagnostics 2022; 12: 2406
• 12 Chen W, Chen H, Mi L. et al. Subfoveal Choroidal Thickness After Femtosecond Laser-Assisted Cataract Surgery for Age-Related Cataracts. Front Med (Lausanne) 2022; 9: 826042
• 13 Noda Y, Ogawa A, Toyama T. et al. Long-term increase in subfoveal choroidal thickness after surgery for senile cataracts. Am J Ophthalmol 2014; 158: 455-459.e1
• 14 Pierru A, Carles M, Gastaud P. et al. Measurement of subfoveal choroidal thickness after cataract surgery in enhanced depth imaging optical coherence tomography. Invest Ophthalmol Vis Sci 2014; 55: 4967-4974
• 15 Yılmaz T, Karci AA, Yilmaz İ. et al. Long-Term Changes in Subfoveal Choroidal Thickness After Cataract Surgery. Med Sci Monit 2016; 22: 1566-1570
• 16 Sourdille P, Santiago PY. Optical coherence tomography of macular thickness after cataract surgery. J Cataract Refract Surg 1999; 25: 256-261
• 17 Biro Z, Balla Z, Kovacs B. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation. Eye (Lond) 2008; 22: 8-12
• 18 Xu H, Chen M, Forrester JV. et al. Cataract surgery induces retinal pro-inflammatory gene expression and protein secretion. Invest Ophthalmol Vis Sci 2011; 52: 249-255
• 19 Grzybowski A, Sidaraite A, Zemaitiene R. Management of inflammation after the cataract surgery. Curr Opin Ophthalmol 2023; 34: 9-20
• 20 Cevher S, Aydoğdu G. How does nepafenac affect the choroidal thickness after uneventful cataract surgery?. Eur J Ophthalmol 2021; 31: 2319-2328
• 21 Blair NP, Tan MR, Felder AE. et al. Retinal Oxygen Delivery, Metabolism and Extraction Fraction and Retinal Thickness Immediately Following an Interval of Ophthalmic Vessel Occlusion in Rats. Sci Rep 2019; 9: 8092
• 22 Lou L, Ostrin LA. Effects of Monocular Light Deprivation on the Diurnal Rhythms in Retinal and Choroidal Thickness. Invest Ophthalmol Vis Sci 2022; 63: 6
• 23 Poley BJ, Lindstrom RL, Samuelson TW. et al. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg 2009; 35: 1946-1955
• 24 Caprioli J, Coleman AL. Blood pressure, perfusion pressure, and glaucoma. Am J Ophthalmol 2010; 149: 704-712
• 25 Aslan Bayhan S, Bayhan HA, Muhafiz E. et al. Evaluation of choroidal thickness changes after phacoemulsification surgery. Clin Ophthalmol 2016; 10: 961-967
• 26 Yonekawa Y, Kim IK. Pseudophakic cystoid macular edema. Curr Opin Ophthalmol 2012; 23: 26-32
• 27 Klein BEK, Howard KP, Lee KE. et al. The relationship of cataract and cataract extraction to age-related macular degeneration: the Beaver Dam Eye Study. Ophthalmology 2012; 119: 1628-1633
• 28 Cugati S, Mitchell P, Rochtchina E. et al. Cataract surgery and the 10-year incidence of age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology 2006; 113: 2020-2025
• 29 Chew EY, Sperduto RD, Milton RC. et al. Risk of advanced age-related macular degeneration after cataract surgery in the Age-Related Eye Disease Study: AREDS Report 25. Ophthalmology 2009; 116: 297-303
• 30 Yiu G, Chiu SJ, Petrou PA. et al. Relationship of central choroidal thickness with age-related macular degeneration status. Am J Ophthalmol 2015; 159: 617-626