Changes Of Retinal And Chorotinal Vessel Density And Thickness In Macular Area After Cataract Surgery In Patients With WAMD

Objective:Optical coherence tomography angiography(OCTA)was used to evaluate the effect of phacoemulsification combined with intraocular lens implantation on vascular density and retinal thickness of macular region and retinal layers in 3 months after macular area with wet age-related macular degeneration(wAMD)combined with cataract.To provide more clinical data supporting evidence for the choice of cataract surgical treatment countermeasures in wAMD patients with cataract.Methods:This study is a retrospective study.Fifty-two eyes(43 patients)with cataract diagnosed in the First People’s Hospital of Yunnan Province were selected as the wAMD group,and 56 eyes(40 patients)were age-related cataract diagnosed without other ocular complications.In wAMD group,intravitreal injection of anti-vascular endothelial growth factor was performed with a 3 + PRN protocol according as Optimal treatment for neovascular age-related macular degeneration-extended protocol consensus in 2022.After review of wAMD condition was stable 2months later,cataract phacoemulsification combined with intraocular lens implantation,and intravitreal injection of anti-VEGF was performed for patients whose retinal thickness and vascular density significantly increased 1 month after surgery.The control group underwent cataract phacoemulsification combined with intraocular lens implantation.Record the best corrected visual acuity(BCVA)in both groups,intraocular pressure(IOP),major intraoperative parameters,OCTA was used to record the 3 * 3mm area of the macular area before and 1 week,1 month and 3 month after the superficial vascular plexus(SVP),the intermediate capillary plexus(ICP),the deep capillary plexus(DCP),the superficial vascular complex(SVC),the deep vascular complex(DVC),the choriocapillaris(CC)vascular density,changes in the mean retinal thickness of the whole,inner,and outer layers in the macular area,and performed correlation analysis.Data collation and analysis were performed for SPSS26.0 statistical software.If measurement data in line with the normal distribution,using(x ± s),two groups in preoperative and postoperative time points of vascular density and the comparison of retinal thickness repeated measurement variance analysis,between two factors in the preoperative and postoperative time points between the two groups each layer of blood vessel density and retinal thickness variation comparison using the Bonferroni test.P <0.05 was considered to be statistically significant.Results:One week after surgery,the visual acuity of the wAMD and control groups improved(P <0.05),the SVP,ICP,DCP,SVC,DVC and CC increased significantly(P <0.05),and the change was higher than that of the control group(P <0.05);the average retinal thickness of the wAMD group increased(P <0.05),and the change compared with the control group is not statistically significant.One month after surgery,SVP,ICP,DCP,SVC,DVC and CC decreased slightly than 1 week,however,it still higher than the level on preoperative(P <0.05),and the vascular density in DCP and CC in the wAMD group was higher than that of the control group(P <0.05);the average retinal thickness of the whole,inner and outer layers increased in the wAMD group(P <0.05),which was higher than the control group(P <0.05).In 3 months after surgery,the visual acuity of patients in the wAMD group improved compared with 1 month(P <0.05);in the wAMD group,the SVP,ICP,DCP,SVC,DVC and CC all decreased,and the change of vascular density at all levels was similar to that of the control group;the average retinal thickness of the wAMD group decreased,and the mean retinal thickness of all levels changed significantly compared with that of the control group.Conclusion:After a standardized anti-VEGF therapy in wAMD patients,cataract phacoemulsification combined with intraocular lens implantation,and postoperative real-time monitoring of the macular vascular density and retinal thickness,such as the increase of density or thickness,timely vitreous cavity against VEGF treatment,to a certain extent to improve wAMD and cataract patients have certain safety guarantee and feasibility.