A study published in the journal Diagnostics investigated the long-term implications of uncomplicated phacoemulsification on macular retinal perfusion using optical coherence tomography angiography in healthy aging patients.
Study: Long-Term Functional Hyperemia after Uncomplicated Phacoemulsification: Benefits beyond Restoring Vision. Image Credit: Chaikom/Shutterstock.com
Uncomplicated Cases of Phacoemulsification
Phacoemulsification restores the vision of cataract patients. It is a modern cataract surgery that uses ultrasonic energy to break the eye’s lens into tiny fragments that are then suctioned out of the eye.
In uncomplicated cases, the objective is to implant an intraocular lens in the capsular bag. However, in the event of complications, intraocular lenses can be easily inserted in the sulcus with appropriate capsular support.
The impact and persistence of phacoemulsification on the blood vessels of the macula (part of the retina) are still debatable. In earlier research, an increase in macular thickness following uncomplicated phacoemulsification was associated with local inflammatory response.
However, in contrast to this adverse inflammatory effect, which subsides within three months, the functional hyperemia phenomenon has been proposed as the reason for the alterations in the retinal microvasculature.
Therefore, it is essential to study the post-surgical effects of phacoemulsification on macular perfusion.
Significance of Optical Coherence Tomography Angiography in Ophthalmology
The macular vasculature has been studied by ophthalmologists using several techniques, such as fundus cameras and fundus fluorescein angiography.
Although these techniques offer valuable clinical data, their utility in clinical settings is constrained by their invasiveness or low resolution. Furthermore, it is difficult to track early and subtle alterations in the macular capillary network in clinical settings.
Therefore, a non-invasive and efficient tool for monitoring macular perfusion would provide early detection of alterations associated with various illnesses, allowing for early therapies and a deeper understanding of the biology of macular vascular disease.
New imaging methods, such as optical coherence tomography angiography, allow for the quantitative assessment of retinal and choroidal layers and the evaluation of a single retinal layer. In addition, optical coherence tomography angiography permits the detection of novel intra-retinal abnormalities, such as hyper-reflective intra-retinal spots.
Investigating Effects of Uncomplicated Phacoemulsification on Patients with Immature and Incipient Senile Cataracts
This research investigates a novel clinical question: Do cataract surgery’s long-term advantages extend beyond the enhancement of visual acuity?
For this, the current work capitalizes on recent research revealing a three-month increase in macular perfusion following uncomplicated phacoemulsification due to functional hyperemia induced by enhanced retinal light stimulation following cataract removal.
The corneal endothelium was examined under the endothelial biomicroscope. The optical biometer measured the eye’s axial length, and the SRK-T formula was applied to determine the intraocular lens power targeting emmetropia.
The deep vascular complex, superficial vascular complex, and large choroidal and choriocapillaris blood vessels were examined. The level of significance was fixed at p 0.0001.
The nonparametric Friedman ANOVA test was used to compare the vascular and general parameters’ values before phacoemulsification to those obtained after six months, three months, one month, and one week of surgery.
Significant Findings of the Study
The study verified the previously reported data that uncomplicated phacoemulsification caused a long-term increase in macular perfusion linked to functional hyperemia. In addition, it provides a normative database of choroidal and retinal vasculature in healthy elderly patients.
Significant alterations in vascular parameters occurred in all retinal layers except the choroid and choriocapillaris in 95 eyes of 95 patients. These changes peaked one week after treatment and remained constant for six months.
There was a statistically significant increase in vessels percentage area, retinal vessels area, the total number of junctions, total and average vessels length, and junctions’ density, followed by a decline in mean lacunarity and total endpoints, indicating an increase in blood flow.
Macular perfusion had no clinically meaningful impact on choroidal circulation because the external retinal-blood barrier was not breached at a level that would have caused it. Therefore, in light of scientific data defining the best time for phacoemulsification and the possible risks of early cataract surgery, future research should clarify whether the advantages of inducing functional hyperemia exceed the hazards of early cataract surgery.
The development of technology that could record high-resolution, high-quality optical coherence tomography angiography images in denser cataract patients would encourage additional research on this subject.
Additionally, it is necessary to conduct additional research comparing the same post- and pre-surgical vascular parameters to determine whether the same mechanisms can be found in patients with underlying ophthalmologic diseases.
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Ćurić, A., Bjeloš, M., Bušić, M., Kuzmanović Elabjer, B., Rak, B., & Vukojević, N. (2022). Long-Term Functional Hyperemia after Uncomplicated Phacoemulsification: Benefits beyond Restoring Vision. Diagnostics. https://www.mdpi.com/2075-4418/12/10/244