Quantitative Analysis of Choroidal Vascular Remodeling after Cataract Surgery: Correlation with Preoperative Lens Opacity Grading

Abstract

Background Cataract surgery has been shown to induce choroidal remodeling, but the underlying mechanisms remain poorly understood. This study investigates the relationship between preoperative lens opacity and postoperative changes in choroidal vascularity following phacoemulsification.

Methods This prospective study included 46 eyes from 46 patients undergoing routine cataract surgery. Choroidal vascularity was assessed using optical coherence tomography angiography (OCTA) before surgery and at 1, 4, and 12 weeks postoperatively. The choroidal vascularity index (CVI) was calculated using a custom computer script. Preoperative lens opacity was quantified using anterior segment optical coherence tomography (AS-OCT). Correlations between CVI changes and various surgical and anatomical parameters were analyzed.

Results The CVI decreased significantly, from 0.584 ± 0.036 preoperatively to 0.569 ± 0.037 at 12 weeks postoperatively (p = 0.003). There was a significant negative correlation between the change in CVI and preoperative lens density (r = − 0.333, p = 0.036), as well as nuclear density (r = − 0.328, p = 0.039). No significant correlations were found between CVI change and cumulative dissipated energy, phacoemulsification time, fluid usage, or intraocular pressure change.

Conclusion Cataract surgery induces a significant decrease in choroidal vascularity that persists for at least three months postoperatively. This decrease correlates with preoperative cataract density, suggesting that increased light transmission following lens replacement may lead to choroidal remodeling. Consequently, objective measurement of lens opacity may contribute to the decision-making process for timing cataract surgery; however, further studies are needed to evaluate its potential role in minimising short- and long-term complications, such as macular oedema or age-related macular degeneration.

Zusammenfassung

Hintergrund Die Kataraktoperation führt nachweislich zu einer Umgestaltung der Aderhaut, aber die zugrundeliegenden Mechanismen sind noch wenig verstanden. Diese Studie untersucht den Zusammenhang zwischen präoperativer Linsentrübung und postoperativen Veränderungen der Gefäße der Choroidea nach Phakoemulsifikation.

Methoden Diese prospektive Studie umfasste 46 Augen von 46 Patienten, die sich einer Kataraktoperation unterzogen. Die Gefäße der Choroidea wurden mittels optischer Kohärenztomographie Angiographie (OCTA) vor der Operation sowie 1, 4 und 12 Wochen postoperativ beurteilt und quantifiziert. Der choroidale Vaskularitätsindex (CVI) wurde mithilfe eines speziellen Computerskripts berechnet. Die präoperative Linsentrübung wurde mittels optischer Kohärenztomografie des vorderen Augenabschnitts (AS-OCT) quantifiziert. Korrelationen zwischen CVI-Veränderungen und verschiedenen chirurgischen und anatomischen Parametern wurden analysiert.

Ergebnisse Der CVI sank signifikant von 0,584 ± 0,036 präoperativ auf 0,569 ± 0,037 12 Wochen postoperativ (p = 0,003). Es gab eine signifikante negative Korrelation zwischen der Veränderung des CVI und der präoperativen Linsendichte (r = − 0,333, p = 0,036) sowie der Kerndichte (r = − 0,328, p = 0,039). Es wurden keine signifikanten Korrelationen zwischen CVI-Veränderung und kumulativer dissipierter Energie, Phakoemulsifikationszeit, Flüssigkeitsverbrauch oder Veränderung des Augeninnendrucks gefunden.

Schlussfolgerung Die Kataraktoperation führt zu einer signifikanten Abnahme der Gefäße der Choroidea, die mindestens 3 Monate postoperativ anhält. Diese Abnahme korreliert mit der präoperativen Kataraktdichte, was darauf hindeutet, dass eine erhöhte Lichtdurchlässigkeit nach dem Linsenaustausch zu einer Umgestaltung der Aderhaut führen kann. Folglich ist es denkbar, dass die objektive Messung der Linsentrübung als Indikator für den Zeitpunkt der Kataraktoperation dienen könnte, um mögliche langfristige Komplikationen zu minimieren.

Conclusion Box

Already known:

• Cataract surgery is one of the most commonly performed procedures worldwide and is associated with improvements in visual acuity and quality of life, but its effects on choroidal vasculature remain debated.

• Previous studies have shown conflicting results regarding changes in choroidal vascularity after cataract surgery, with some reporting increases, others decreases, and some no significant change, partly due to differences in imaging and analysis techniques.

• It was unclear whether the extent of lens opacity (cataract density) directly influences postoperative changes in choroidal vascularity, and whether these changes are primarily driven by inflammation, intraocular pressure fluctuations, or altered light transmission.

Newly described:

• This study demonstrates that cataract surgery induces a significant and persistent decrease in the choroidal vascularity index (CVI) for at least three months postoperatively.

• The reduction in CVI correlates significantly with preoperative cataract density, as objectively measured by anterior segment OCT, suggesting a direct link between lens opacity and choroidal remodeling.

• The findings indicate that changes in choroidal structure are more closely related to increased light transmission following lens replacement than to inflammation or intraocular pressure changes alone, highlighting the importance of considering cataract density in surgical timing and postoperative management.

Keywords

cataract - choroid - OCTA - OCT - optical coherence tomography - lens density

Schlüsselwörter

Katarakt - Chorioidea - OCTA - OCT - optische Kohärenztomografie - Linsendichte

Publication History

Received: 16 March 2025

Accepted: 23 June 2025

Article published online:
21 August 2025

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