Abstract
Introduction: Cataract is the commonest cause of treatable blindness world-wide, and surgery is the only fruitful modality of its treatment for visual recovery.Clinically macular edema is one of the reported complication after cataract surgery due to inflammatory response. This macular edema could have an effect on final visual acuity so this study was undertaken to evaluate the clinical or sub-clinical alteration in macular thickness after cataract surgery and its effect on visual acuity.
Materials and Method: 180 cataractous eyes posted for surgery were enrolled for study after following the exclusion criteria. All patients underwent OCT macular scan analysis for the central 1mm macular zone to look for macular edema and best corrected visual acuity pre operatively followed by the 1stpost op day, 4th week and 12th week after cataract surgery.
Results: The difference between the preoperative and post operative central subfield and average macular thickness was highly significant after the 4th week of surgery (p=<0.001) while the difference between the preoperative and post operative macular volume (mm3) was found to be highly significant after the 4th and 12th week of surgery (P<0.001). Despite these findings, visual acuity increased significantly by 4th and 12th week of surgery.
Conclusion: Post cataract surgery there occurs an increase in macular thickness which is either clinically or tomographically evident but has no statistically significant correlation with the final visual outcome.
Keywords: Cataract, macular thickness, optical coherence tomography
References
- World Health Organization (WHO). Global Initiative for the Elimination of Avoidable Blindness Action Plan 2006–2011. WHO, 2007.
- Michael R, Bron AJ. The ageing lens and cataract: a model of normal and pathological ageing. Phil. Trans. R. Soc. B 2011; 366: 1278–1292.
- Vision 2020: The Right to Sight India. Guidelines for the Management of Cataract in India, 2011.
- vonJagow B, Ohrloff C, Kohnen T. Macular thickness after uneventful cataract surgery determined by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol.2007 Dec;245(12):1765-71.
- Knez N, Sisko K, Pahor D. Influence of Cataract Surgery on Macular Thickness – a 3-month Follow-up. The Journal of International Medical Research 2011; 39: 1113-1121.
- Gharbiya M, Cruciani F, Cuozzo G, Parisi F, Russo P, Abdolrahimzadeh S. Macular thickness changes evaluated with spectral domain optical coherence tomography after uncomplicated phacoemulsification. Eye 2013; 27: 605–611.
- Falcão MS, Gonçalves NM, Freitas-Costa P, Beato JB, Rocha-Sousa A, Rocha-Sousa Â, Brandão EM, Falcão-Reis FM. Choroidal and macular thickness changes induced by cataract surgery. Clinical Ophthalmology 2014; 8: 55–60.
- Ursell PG, Spalton DJ, Whitcup SM, Nussenblatt RB: Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acquity. J Cataract Refract surg1999;25:1492-1497.
- Nicholas S, Riley A, Patel H, Neveldson B, Purdie G, Wells AP. Correlations between optical coherence tomography measurement of macular thickness and visual acuity after cataract extraction. Clin Experiment Ophthalmol 2006; 34: 124–129.
- Cagini C, Fiore T, Iaccheri B, Piccinelli F, Ricci MA, Fruttini D. Macular thickness measured by optical coherence tomography in a healthy population before and after uncomplicated cataract phacoemulsification surgery. Curr Eye Res 2009; 34: 1036–1041.
- Kusbeci T, Eryigit L, Yavas G, Inan UU. Evaluation of cystoid macular edema using optical coherence tomography and fundus fluorescein angiography after uncomplicated phacoemulsification surgery. Curr Eye Res 2012; 37: 327–333.
- Ching H-Y, Wong AC, Wong C-C, Woo DC, Chan CW. Cystoid macular oedema and changes in retinal thickness after phacoemulsification with optical coherence tomography. Eye 2006; 20: 297–303.
- Georgopoulos GT, Papaconstantinou D, Niskopoulou M, Moschos M, Georgalas I, Koutsandrea C. Foveal thickness after phacoemulsification as measured by optical coherence tomography. Clinical Ophthalmology 2008; 2(4): 817–820.
- Blumenkranz MS , Halter JA, Kuppermann BD, Williams GA, Ip M, Davis M, Weinberg DV, Chou C, Whitcup SM, Correlation of visual acquity and macular thickness measured by optical coherence tomography in patients with persistent macular edema. Retina 2010 Jul-Aug;30(7):1090-4.
- Larsson J, Zhu M, Sutter F, Gillies MC. Relation between reduction of foveal thickness and visual acquity in diabetic macular edema treated with intravitreal triamcinolone. Am J Ophthalmol.2005 May;139(5):802-6.
- AppukuttanB,Giridhar A ,Gopalakrishnan M, Sivaprasad S, Normative spectral domain optical coherence tomography data on macular and retinal nerve fibre layer thickness in Indians ,Indian J Ophthalmol 2014;62:316-21.
- Miyake K & Ibaraki N (2002): Prostaglandins and cystoid macular edema. Surv Ophthalmol 47 (Suppl. 1): S203–S218.
- Yavas GF, Ozturk F &Kusbeci T (2007): Preoperative topical indomethacin to prevent pseudophakic cystoid macular oedema. J Catract Refract Surg 33: 804–807.
- Voo I, Mavrofrides EC & Puliafito CA (2004): Clinical applications of optical coherence tomography for the diagnosis and management of macular diseases. Oph- thalmol Clin North Am 17: 21–31.
- Nicholas S, Riley A, Patel H, Neveldson B, Purdie G, Wells AP. Correlations between optical coherence tomography measurement of macular thickness and visual acuity after cataract extraction. Clin Experiment Ophthalmol.2006;34:124–129.
- Perente I, Utine CA, Ozturker C, Cakir M, Kaya V, Eren H, et al. Evaluation of macular changes after uncomplicated phacoemulsification surgery by optical coherence tomography. Curr Eye Res. 2007;32:241–247.
- Biro Z, Balla Z, Kovacs B. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation. 2008;22:8–12.
- Kusbeci T, Eryigit L, Yavas G, Inan UU. Evaluation of cystoid macular edema using optical coherence tomography and fundus fluorescein angiography after uncomplicated phacoemulsification surgery. Curr Eye Res. 2012;37:327–333.
- Ghosh S,Roy I, Biswas PN, Maji D, Mondal LK, Mukhopadhyay S, Bhaduri G. Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery. Acta Ophthalmol. 2010 Jun;88(4):e102-6. doi: 10.1111/j.1755-3768.2010.01896.x.
- Kurz S,Krummenauer F, Thieme H, Dick HB. Optical coherence tomography of macular thickness after biaxial vs coaxial microincision clear corneal cataract surgery. Eur J Ophthalmol. 2009 Nov-Dec;19(6):990-7.
- Hwang HS,Ahn YJ, Lee HJ, Kim MS, Kim EC. Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery. Acta Ophthalmol. 2015 Apr 1. doi: 10.1111/aos.12716.
- Sourdille P, Santiago PY. 1999. Optical coherence tomography of macular thickness after cataract surgery. J Cataract Refract Surg, 25:256–61.
- Georgopoulos GT, Papaconstantinou D, Niskopoulou M, Moschos M, Georgalas I, Koutsandrea C. Foveal thickness after phacoemulsification as measured by optical coherence tomography. Clinical Ophthalmology (Auckland, NZ). 2008;2(4):817-820.
Corresponding Author
Dr Akansha Sharma
Junior Resident, Department of Ophthalmology, Era’s Lucknow Medical College and Hospital, Lucknow
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.133
