| Purpose: To evaluate macular vascular density and retinal thickness changes after phacoemulsification combined with foldable intraocular lens implantation in age-related cataract patients using optical coherence tomography angiography（OCTA）.Methods:40 patients（56 eyes）who met the inclusion criteria for phacoemulsification combined with foldable intraocular lens implantation hospitalized at the First People’s Hospital of Yunnan Province from June 2021 to December 2021 were selected.The cumulative dissipated energy was 25.98±3.50% and the effective phacoemulsification time was 40.95±7.24 s.At the time of before phacoemulsification,1week,1 month and3 months postoperative,OCTA was used to non-invasively obtain vascular and retinal thickness’ s images of the 3*3 mm scan range in the macular region.We observed the changes and trends of vascular density before and after surgery,contained the layers of superficial vascular complex（SVC）,superficial vascular plexus（SVP）,intermediate capillary plexus（ICP）deep vascular complex（DVC）and deep capillary plexus（DCP）.We also observed the changes and trends of retinal thickness before and after surgery,contained the central macular thickness（CMT）,inner central macular thickness（ICMT）,parafovea retinal thickness（PFRT）,and inner parafovea retinal thickness（PFRT）.Since all retinal microvascular levels in the macula included in this study were inner retinal blood supply,and IPFRT was the average thickness of the inner retinal layer in the paracentral sulcus after cutting out the avascular area of the macular central sulcus,we correlated DVC,DCP,ICP,SVC,and SVP with IPFRT for each postoperative moment with the preoperative change rate.The best corrected visual acuity（BCVA）of the patients after surgery was also recorded.According to the effect of cataract ultrasound emulsification combined with foldable intraocular lens implantation implantation on macular retinal thickness and microvessel density in patients with age-related cataract,and the correlation between the postoperative and preoperative change rates between the two,as a way to help investigate the mechanism of pseudophakic cystoid macular edema（PCME）occurrence after cataract surgery.Results:1.The effect of phacoemulsification on the average retinal thickness of each layer in macular area: the comparison results of CMT,ICMT,PFRT,and IPFRT at different follow-up times showed that: preoperative < 1 week postoperative < 3 months postoperative < 1 month postoperative,the overall P < 0.001 for each index,and the difference was statistically significant.Compared with the preoperative,CMT increased at 1 week postoperatively（P > 0.05）and 1 month postoperatively（P < 0.05）,showing a gradual increase,and a decreasing trend at 3 months postoperatively,but still higher than the preoperative level（P < 0.05）.Compared with the preoperative level,ICMT,PFRT,and IPFRT increased at 1 week postoperatively（P < 0.05）and 1 month postoperatively（P < 0.05）,showing a gradual upward trend,and showed a downward trend at 3 months postoperatively,but still higher than the preoperative level（P < 0.05）.However,the increase in mean retinal thickness at all levels were less than the preoperative level of 3 standard deviations.2.The effect of phacoemulsification on the vascular density in the macular area in each layer: the comparison results of DVC and SVC on different follow-up times showed that: preoperative < 3 months postoperative < 1 month postoperative < 1 week postoperative,the overall P < 0.05 for each index,and the difference was statistically significant.Compared with the preoperative,the vascular density in the macular area of the DVC and SVC layers increased at 1 week postoperatively（P < 0.05）,and gradually decreased at 1 month and 3 months postoperatively,but was still higher than the preoperative level（P < 0.05）.The comparison of DCP,ICP,and SVP at different follow-up times showed that: preoperative < 1 month postoperative < 3 months postoperative < 1 week postoperative,and the overall P < 0.05 for each index,and the difference was statistically significant.Compared with the preoperative,the vascular density in the macular area of SVP and DCP layers increased at 1 week postoperatively（P < 0.05）and showed a decreasing trend at 1 month postoperatively,but was still higher than the preoperative level（P < 0.05）.Compared with the preoperative level,the vascular density in the macular area in the ICP layer increased at 1 week postoperatively（P < 0.05）and showed a decreasing trend at 1 month postoperatively,returning to the preoperative level（P > 0.05）.3.Correlation the rates of change between average retinal thickness and vascular density in macular area after phacoemulsification:The results of our study showed that the rate of change between 1 week postoperatively and preoperatively showed a positive correlation between IPFRT and DCP and SVP,and the correlation coefficient was statistically significant（P < 0.05）.There was no correlation between the rate of change between DVC,ICP,SVC and IPFRT at 1 week postoperatively and preoperatively（P >0.05）.There was no correlation between the rate of change between DVC,DCP,ICP,SVC,SVP and IPFRT at 1 month and 3 months postoperatively and preoperatively（P >0.05）.4.Changes in best-corrected visual acuity after phacoemulsification: The results of this study showed that the BCVA of all subjects in this study remained stable in the range of0.8-1.2 at 1 week,1 month,and 3 months after surgery and did not change significantly over time.Conclusions: 1.In our study,we selected age-related cataract patients with LOCS-N:2+～ 3+ grade,cumulative dissipated energy at 25.98 ± 3.50%,effective phacoemulsification time in 40.95 ± 7.24 s,undergiong phacoemulsification combined with foldable intraocular lens implantation.This conditian were less likely to cause intraoperative and postoperative complications,but may still lead to some degree of increase in postoperative mean retinal thickness and microvascular density in the macula by OCTA examination.2.None of the postoperative changes of macular cystoid edema were found in our study,and no decrease in BCVA due to changes in mean retinal thickness and vascular density in the macula area.The changes of mean retinal thickness and vascular density in the macula area showed a subclinical increase.3.In our study,we found that SVP and DCP layer macular vascular density may be more closely related to the occurrence of PCME after cataract surgery. |
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