Macular optical coherence tomography before cataract surgery

Abstract

Purpose: To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD-OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery. Methods: In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System. Results: Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age-related macular degeneration in four eyes (12.12%). Full-thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions ( P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years ( P = 0.025 and odds ratio [OR] =11.12), smoking history ( P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%). Conclusions: Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.

The Outcome of Artisan Intraocular Lens Implantation in Children: A Narrative Review

“…It is also one of the treatable causes of vision loss in childhood [42]. The necessity for cataract treatment is different according to cataract progression as well as the density of opacities at birth and in the course of childhood [43]. The management of aphakia can be either conservative or surgical.…”

“…Postoperative intraocular inflammation is usually more severe in younger children. Additionally, in cases under two years old, lens implantation following cataract removal may cause a myopic shift [43,47,48].…”

“…With sufficient surgical experience and rigorous follow-up, IOL implantation may have an acceptable complication rate in children up to 2 years old with bilateral cataracts [46]. We must make careful decisions about the implantation lens schedule for children, considering factors such as the patient's age, potential consequences, the cost-effectiveness of the treatment for their families, and the selection of the appropriate IOL type and power [43]. Research demonstrates that when an experienced surgeon performs elective surgery after elementary school age, the risk of high myopia and complication rate is low, the predictable refractive outcome is higher, and there are fewer adverse events [49].…”

Cataract surgery in myopic eyes

“…Macular optical coherence tomography has been recommended prior to cataract surgery even in the presence of normal clinical examination, as it may detect occult macular lesions and potentially change the surgical planning and prognosis accordingly [13,14].…”