Pre-Cataract Surgery Macular Changes Detectable With OCT

Pre-cataract surgery macular changes in patients older than 60 years of age can be detected using optical coherence tomography (OCT), even when those changes are not observable via clinical examination, according to research published in the Journal of Cataract and Refractive Surgery.

Researchers at a single center conducted a cross-sectional prospective study to evaluate the importance of OCT in identifying pre-cataract surgery macular changes that go undetected during clinical examination prior to cataract surgery in patients older than 60 years of age. 

The study was conducted between July 2020 and July 2021. Patients older than 60 years of age undergoing preoperative ophthalmological evaluation for cataract surgery were screened for inclusion in the study. Those with a previous diagnosis or clinical evidence of macular disease, or with media opacity preventing OCT were excluded.

All study participants underwent OCT and were classified as either patients without macular changes or patients with macular changes identified by OCT.

A total of 300 eyes of 180 patients (mean age, 70.9±6.8 years; range, 60-92; 57% women and 43% men) were included in the study. Most (70.7%) patients had a personal history of comorbidity, including 60.3% with systemic arterial hypertension and 35.4% with diabetes mellitus, and a history of smoking was reported by 4.4%.

The researchers reported OCT-identified macular changes in 13.3% of eyes, including age-related macular degeneration (4.3%), epiretinal membrane (4%), intraretinal fluid (4%), and macular hole (1%). 

The team found patients with pre-cataract surgery macular changes were older (mean age, 74.4 vs 70.4; P <.001) and more frequently had a history of comorbidity or smoking, or both, than those with no macular changes (87.5% vs 68.1%; P <.05). 

“Detecting macular changes prior to phacoemulsification enables better planning and precision in the choice of IOLs, meeting the expectations of the surgeon and, principally, of the patient in an individualized manner,” the researchers report. “Despite the high operational cost of OCT, its expressive effectiveness in the preoperative evaluation of the population over 60 years of age brings greater equilibrium to the cost-benefit relationship by establishing a realistic prognosis and contributing to more realistic expectations of post-surgical outcomes.”

The primary limitation of the study was the cross-sectional, single-center design.