Alterations in Thickness of Macula after Uncomplicated Cataract Surgery


Authors : Dr. Nitisha Bhimavarapu; Dr. M. Parni Kumar

Volume/Issue : Volume 9 - 2024, Issue 2 - February

Google Scholar : http://tinyurl.com/524xceyt

Scribd : http://tinyurl.com/me3acr3n

DOI : https://doi.org/10.5281/zenodo.10696581

Abstract : Purpose Evaluate alterations in thickness of macula after uncomplicated cataract surgery, to clarify the optical tomographic characteristics of thickness of macula after uncomplicated cataract surgery, and also compare the changes in thickness of macula after uncomplicated phacoemulsification and manual small incision cataract surgery.  Patients and Methodology The study included a cohort of fifty patients, consisting of 28 males and 22 females. The age range of the participants was between 35 and 78 years, with a mean age of 58.6 years. Out of the total, 25 individuals (50%) underwent small incision cataract surgery (SICS) in one eye with "in the bag" method of intraocular lens (IOL) made up of polymethylmethacrylate implantation, while the other 25 participants (50%) underwent phacoemulsification in one eye with "in the bag" method of foldable IOL made up of acrylic. The exclusion criteria included cataracts that were too mature for pre-surgical OCT, pathology involving the retina, traumatic or complex cataracts, and complications during surgery. The measurement of best corrected visual acuity was conducted, and optical coherence tomography (OCT) was performed before and after the surgery to assess macular thickness. The patients were reviewed at one week, two week, and four weeks post-surgery, as well as three months post- surgery.  Outcome Among the 50 participants who had undergone cataract surgery, subclinical macular edema was observed at the first week, second week , and fourth week evaluations. The highest level of subclinical macular edema was observed during the first week evaluation. However, during the third month evaluation, the macular edema had diminished. Statistically significant differences (P<0.01) were observed between the mean thickness of macula values before and after surgery at the 1st, 2nd, and 4th week post-operation. Within the SICS group Statistically significant differences (P<0.01) were observed between the mean macular thickness values before and after surgery in the first, second, and fourth weeks. Within the Phaco group Statistically significant differences (P<0.05) were observed between the mean values of macular thickness before surgery and during the first week after surgery, before surgery and during the second week after surgery, and during the first week after surgery and the fourth week after surgery. A notable subclinical alteration occurred in the thickness of the macula, without any impact on visual acuity. None of the participants in the current research exhibited cystoid macular edema. Upon comparing both groups, it was observed that the SICS group exhibited a prolonged subclinical macular edema until the fourth week review. Conversely, in patients who underwent phacoemulsification, an increase in retinal thickness was observed until the second week review. However, there were no statistically significant differences in the average macular thickness values between the two groups before surgery (t (d.f.=46) = 0.98; P>0.05), at review of 1 week (t (d.f.=46) = 1.08; P>0.05),review at 2 weeks (t (d.f.=46) = 0.74; P>0.05), review at 4 weeks (t (d.f.=46) = 0.64; P>0.05), and review at 3 months (t (d.f.=46) = 0.23; P>0.05) after surgery.  Conclusion Subclinical macular edema develops following uncomplicated cataract surgery, reaching its highest point one week after the procedure and persisting for a maximum of four weeks. The optical coherence tomography (OCT) scan revealed the presence of macular edema, which did not cause any changes to the macular structure . The period of subclinical macular edema is extended in eyes that undergo manual small incision cataract surgery (SICS) compared to those that undergo phacoemulsification. This edema does not have any impact on visual acuity.

Keywords : Manual Small Incision Cataract Surgery(SICS) , Phaco Emulsification , Optical Coherence Tomography(OCT), Polymethyl Methacrylate(PMMA) , Intraocular Lenses (Iols).

Purpose Evaluate alterations in thickness of macula after uncomplicated cataract surgery, to clarify the optical tomographic characteristics of thickness of macula after uncomplicated cataract surgery, and also compare the changes in thickness of macula after uncomplicated phacoemulsification and manual small incision cataract surgery.  Patients and Methodology The study included a cohort of fifty patients, consisting of 28 males and 22 females. The age range of the participants was between 35 and 78 years, with a mean age of 58.6 years. Out of the total, 25 individuals (50%) underwent small incision cataract surgery (SICS) in one eye with "in the bag" method of intraocular lens (IOL) made up of polymethylmethacrylate implantation, while the other 25 participants (50%) underwent phacoemulsification in one eye with "in the bag" method of foldable IOL made up of acrylic. The exclusion criteria included cataracts that were too mature for pre-surgical OCT, pathology involving the retina, traumatic or complex cataracts, and complications during surgery. The measurement of best corrected visual acuity was conducted, and optical coherence tomography (OCT) was performed before and after the surgery to assess macular thickness. The patients were reviewed at one week, two week, and four weeks post-surgery, as well as three months post- surgery.  Outcome Among the 50 participants who had undergone cataract surgery, subclinical macular edema was observed at the first week, second week , and fourth week evaluations. The highest level of subclinical macular edema was observed during the first week evaluation. However, during the third month evaluation, the macular edema had diminished. Statistically significant differences (P<0.01) were observed between the mean thickness of macula values before and after surgery at the 1st, 2nd, and 4th week post-operation. Within the SICS group Statistically significant differences (P<0.01) were observed between the mean macular thickness values before and after surgery in the first, second, and fourth weeks. Within the Phaco group Statistically significant differences (P<0.05) were observed between the mean values of macular thickness before surgery and during the first week after surgery, before surgery and during the second week after surgery, and during the first week after surgery and the fourth week after surgery. A notable subclinical alteration occurred in the thickness of the macula, without any impact on visual acuity. None of the participants in the current research exhibited cystoid macular edema. Upon comparing both groups, it was observed that the SICS group exhibited a prolonged subclinical macular edema until the fourth week review. Conversely, in patients who underwent phacoemulsification, an increase in retinal thickness was observed until the second week review. However, there were no statistically significant differences in the average macular thickness values between the two groups before surgery (t (d.f.=46) = 0.98; P>0.05), at review of 1 week (t (d.f.=46) = 1.08; P>0.05),review at 2 weeks (t (d.f.=46) = 0.74; P>0.05), review at 4 weeks (t (d.f.=46) = 0.64; P>0.05), and review at 3 months (t (d.f.=46) = 0.23; P>0.05) after surgery.  Conclusion Subclinical macular edema develops following uncomplicated cataract surgery, reaching its highest point one week after the procedure and persisting for a maximum of four weeks. The optical coherence tomography (OCT) scan revealed the presence of macular edema, which did not cause any changes to the macular structure . The period of subclinical macular edema is extended in eyes that undergo manual small incision cataract surgery (SICS) compared to those that undergo phacoemulsification. This edema does not have any impact on visual acuity.

Keywords : Manual Small Incision Cataract Surgery(SICS) , Phaco Emulsification , Optical Coherence Tomography(OCT), Polymethyl Methacrylate(PMMA) , Intraocular Lenses (Iols).

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