Retrospective evaluation of changes in choroidal thickness after cataract surgery

Retrospective evaluation of changes in choroidal thickness after cataract surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective evaluation of changes in choroidal thickness after cataract surgery Weizhen Wu, Songguo Li, Xiaolei Zhang, Luping Wang, Hongbin Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4765978/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 May, 2025 Read the published version in European Journal of Medical Research → Version 1 posted 23 You are reading this latest preprint version Abstract In this retrospective study, we investigated the changes in choroidal thickness (CT) using enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) and intraocular pressure (IOP) following phacoemulsification. Twenty eyes of 18 patients who underwent phacoemulsification and intraocular lens implantation were included in this study. All patients underwent a detailed ophthalmologic examination. Enhanced depth imaging spectral domain-optical coherence tomography was used to measure CT preoperatively, and postoperatively at days three and ten, and months one, three, and six. CT was measured at the fovea and at points 1.5 mm and 3.0 mm nasal and temporal to the fovea. The data were compared using one-way analysis of variance. The correlation between the changes in the CT and IOP in all sectors was analyzed. There were statistically significant changes in CT and IOP after cataract surgery ( P < 0.05). The IOP reached a minimum (10.43 ± 1.64 mmHg) at six months postoperatively. CT increased at the fovea, 1.5 mm and 3 mm nasal to the fovea postoperatively, and gradually thickened over time, reaching a peak (288.87 ± 67.70 µm) at six months postoperatively. The CT increase was negatively correlated with the decrease in IOP within six months after surgery ( P < 0.05). Our study demonstrated that after cataract surgery, the IOP decreased and the choroid thickened, lasting up to 6 months. Studying the changes in CT and IOP after cataract surgery will help deepen the understanding of fundus diseases associated with cataract surgery and will also play a guiding role in solving clinical complications. choroidal thickness intraocular pressure cataract surgery enhanced depth imaging spectral domain-optical coherence tomography Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Phacoemulsification has become the most commonly used procedure for the treatment of cataracts. Studies have shown that abnormal changes in macular retinal and choroidal thickness (CT) may occur after cataract surgery [ 1 ], and lesions of the macula are one of the main causes of poor visual recovery after cataract surgery [ 2 ]. CT varies greatly with the degree of blood vessel filling. Abnormal choroidal blood vessels and blood volume can cause many retinochoroidal diseases, such as central serous chorioretinopathy, age-related macular degeneration, and polypoidal choroidal vasculopathy [ 3 , 4 ]. Therefore, studying changes in CT after cataract surgery will also help to further increase our understanding about the pathogenesis of macular disease, and ultimately improve postoperative vision quality. In existing clinical studies, CT after cataract surgery has only been followed-up for less than 3 months and was found to be thickened [ 5 ]. However, the mechanism of change in CT in the 6 months following cataract surgery and the time required for CT to stabilize remain unknown. Therefore, in this study, enhanced depth imaging spectral domain-optical coherence tomography (EDI SD-OCT) was used to measure the CT of the fovea and certain adjacent areas within 6 months after cataract surgery to further explore the impact of phacoemulsification on CT and provide evidence for the occurrence of clinically related diseases. Moreover, intraocular pressure (IOP) changes following cataract surgery were measured to explore the correlation between changes in CT and IOP. Materials and Methods General information This was a retrospective study that enrolled a total of 20 eyes from 18 patients who underwent phacoemulsification surgery from July 2016 to December 2019 at the Beijing Friendship Hospital. All patients enrolled were evaluated preoperatively. We excluded the patients with cataracts combined with other ocular complications, including glaucoma, retinal vascular disorders, diabetic retinopathy and macular degeneration. Patients with systemic chronic diseases and a history of smoking were excluded. The grade of lens opacities was determined preoperatively using the Lens Opacities Classification System III. Best-corrected visual acuity, slit-lamp examination, fundus exam, IOP, and EDI SD-OCT (Heidelberg, Germany) were performed in all patients preoperatively and 3 days, 10 days, 1 month, 3 months, and 6 months postoperatively. The study was approved by the ethics committee of the Beijing Friendship Hospital. Operation method The operations were performed by the same experienced ophthalmologist using a phacoemulsification machine (Alcon, United States). Phacoemulsification surgery was performed via a 3.0 mm clear corneal incision. An intraocular lens (Rayner, UK) was implanted; the same type and brand of lens was used in all cases. No complications occurred during the operations. All patients were prescribed postoperative antibiotic and prednisolone acetate eye drops four times daily and tapering by one drop every week for 4 weeks. EDI SD-OCT examination CT was defined as the vertical distance between the outer edge of the retinal pigment epithelium and the inner boundary of the sclera [ 6 ]. EDI SD-OCT was used to scan the macula and measure the CT at the fovea and at points 1.5 mm and 3 mm nasal and temporal to the fovea, using the system's measuring tools (Fig. 1 ). The IOP was measured three times with an applanation tonometer, and the mean value was used in the analysis. All examinations and measurements were completed by two physicians, and the results were verified for reproducibility. Statistical analysis Version 26.0 IBM SPSS Statistics for Windows (IBM Corp., Armonk, N.Y., USA) software was used for statistical analysis. The research data are expressed as mean ± standard deviation. The differences between preoperative and postoperative data were compared by one-way analysis of variance. The relationship between CT and IOP changes was analyzed using Pearson correlation, and statistical significance was set as P < 0.05. Results For this study, we enrolled a total of 20 eyes from 18 patients (7 men, 11 women) with a mean age ± standard deviation of 71.36 ± 8.23 years (range, 65–85 years). Changes in IOP before and after cataract surgery Pairwise comparison results of preoperative and postoperative IOP showed a gradual decrease (Fig. 2 ), and the difference in IOP between the two groups was statistically significant ( P < 0.05) (Table 1 ). Table 1 Comparison of intraocular pressure Time after surgery IOP (mmHg) F P Before surgery 14.69 ± 2.83 5.722 0.000 3 days 12.90 ± 2.66 10 days 12.71 ± 2.66 1 month 12.13 ± 2.89 3 months 11.03 ± 1.62 6 months 10.43 ± 1.64 Values are presented as mean ± standard deviation. IOP, intraocular pressure. Changes in CT following cataract surgery Pairwise comparison of the preoperative and postoperative CT showed a gradual increase (Fig. 3 ). The CT at the subfoveal, 1.5 mm and 3.0 mm nasal to the fovea, had statistically significant differences at different time points ( P < 0.05) (Tables 2 ). Table 2 Choroidal thickness measurements before and after cataract surgery Subfoveal CT, µm CT 1.5 mm nasal to the fovea, µm CT 3.0 mm nasal to the fovea, µm CT 1.5 mm temporal to the fovea, µm CT 3.0 mm temporal to the fovea, µm Before surgery 213.20 ± 52.10 173.87 ± 53.56 120.67 ± 41.06 194.53 ± 55.59 205.07 ± 53.18 3 days after surgery 234.07 ± 60.37 206.80 ± 76.73 138.20 ± 48.67 234.73 ± 80.59 222.93 ± 70.49 10 days after surgery 258.13 ± 64.23 227.80 ± 90.21 153.33 ± 44.40 238.53 ± 78.59 240.87 ± 59.23 1 month after surgery 264.93 ± 68.96 244.53 ± 99.67 169.40 ± 52.52 244.47 ± 85.50 250.80 ± 64.26 3 months after surgery 274.87 ± 63.54 271.27 ± 85.90 178.80 ± 35.89 260.67 ± 83.27 263.67 ± 80.13 6 months after surgery 288.87 ± 67.70 289.53 ± 86.07 211.47 ± 47.31 269.20 ± 80.89 276.00 ± 84.60 F 2.891 3.876 7.506 1.672 2.124 P 0.019 0.003 0.000 0.150 0.070 Values are presented as mean ± standard deviation. CT, choroidal thickness. Correlation between decrease in IOP and change in CT at different time points after surgery Within 6 months after cataract surgery, the increase in CT at all regions measured by EDI SD-OCT was negatively correlated with the decrease in IOP ( P 0.05). Table 3 Correlation between changes in intraocular pressure and choroidal thickness within 6 months following cataract surgery Change in IOP r P Subfoveal CT −0.965 0.002 CT 1.5 mm nasal to the foveal −0.989 0.000 CT 3.0 mm nasal to the foveal −0.959 0.003 CT 1.5 mm temporal to the foveal −0.987 0.000 CT 3.0 mm temporal to the foveal −0.983 0.000 CT, choroidal thickness; IOP, intraocular pressure. Discussion The results of this study show that IOP gradually decreased for 6 months after cataract surgery, reaching the lowest value at the end of this period. Handzel et al. [ 7 ] have found that corneal thickening can occur in the short term after cataract surgery. Although corneal thickening can lead to high IOP measurements, the multiple factors that cause IOP to drop are much greater than the effect of corneal thickness on IOP. This may be related to the removal of the compression on Schlemm’s canal, and the trabecular meshwork caused by the cataractous lens. In addition, the use of viscoelastic agents and continuous infusion of fluid into the anterior chamber during the operation plays a role in openin g the anterior chamber angle, thereby deepening the anterior chamber after the operation and causing a trend toward a further decrease in IOP. As early as 1945, a study [ 8 ] had proposed the theory that cataract surgery would cause a drop in IOP. Cataract surgery can also reduce the secretory function of the ciliary body, an increase in the release of endogenous prostaglandins, and changes in the postoperative blood-aqueous barrier function, all of which can lead to a decrease in postoperative IOP [ 9 ]. From this study, it is evident that the gradual decrease in IOP after cataract surgery is statistically significant ( P < 0.05). In this study, statistically significant changes were observed in CT after cataract surgery. The CT increased gradually starting three days after surgery and peaked six months postoperatively. However, the increase in CT varied among the anatomical regions measured. The mechanism of and factors influencing the changes in CT after cataract surgery remain unclear [ 10 ]. Clinical studies have shown that the CT of the macular fovea preoperatively and postoperatively are significantly correlated with each other, while the changes in CT are not significantly correlated with age, axial length, or surgery duration [ 11 ]. We speculate that surgical mechanical damage and ultrasound energy cause the release of a large amount of inflammatory mediators, which destroy the blood-retinal barrier, leading to increased vascular permeability, and ultimately, to choroidal thickening. Research [ 12 ] has found that femtosecond laser-assisted cataract surgery has less impact on choroidal function than traditional surgery. It also showed that reducing mechanical manipulations during surgery can reduce the release of inflammatory factors and prostaglandins, thereby reducing damage to the blood-retinal barrier [ 12 ]. Under normal circumstances, the inflammatory response after cataract surgery lasts for about one month, but the results from this study showed that the CT gradually increased for 6 months after cataract surgery, demonstrating that there are other factors that affect the changes in CT. Some scholars believe that the expression of specific genes after cataract surgery can also cause changes in choroidal function. Related animal experiments have shown that extracapsular lens removal can cause a significant increase in the gene expression of vascular endothelial growth factor and fibroblast growth factor in the choroid. Thus, the permeability of the choroidal capillaries increases, which leads to thickening of the choroid [ 13 ]. By statistically analyzing the relationship between the changes in CT at different anatomical regions after cataract surgery and with the decrease in IOP, we found that within 6 months after the operation, the increase in CT at the five measurement regions and the decrease in IOP were significantly negatively correlated. However, within one month after surgery, the changes in CT and IOP were not statistically significant. It is speculated that the increase in macular foveal CT at 3 months and 6 months after cataract surgery may be related to the increase in ocular perfusion pressure caused by the drop in IOP after cataract surgery. Various factors, including the increase of intraocular inflammatory mediators and prostaglandins, and the use of local drugs within a month after surgery, may influence the IOP and choroidal capillary blood flow; therefore, there is no statistical relationship between the changes in CT and IOP within a month after surgery. The study by Ohsugi et al. [ 14 ]showed that the changes in the SFCT and IOP after cataract surgery were significantly negatively correlated. Many studies have shown that the increase in macular CT is significantly related to ocular perfusion pressure [ 15 – 17 ], and the measurement of CT in the macular area may indirectly indicate the perfusion state of the blood vessels in the macular area. Therefore, studying the changes in CT after cataract surgery will also play a role in the diagnosis and treatment of macular diseases. In existing clinical studies, the postoperative follow-up time is generally less than 3 months, but the present study followed-up with patients for up to 6 months after surgery and found that CT had still not stabilized. Our data clearly show the trends in CT changes within 6 months after cataract surgery. Due to the small sample size, the reliability of data in our study may be limited. Conclusions In conclusion, statistical analysis of changes in CT evaluated by EDI SD-OCT and IOP after cataract surgery via phacoemulsification will help deepen the understanding of fundus diseases associated with cataract surgery and will also play a guiding role in solving clinical complications. In future research, we will expand the sample size, extend the follow-up time, add more variables or control groups, and conduct further research and analysis on the changes in CT after cataract surgery. Declarations Data Availability The data supporting the conclusions of this article are included within the article. Conflicts of Interest The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper. Funding Statement No Funding. Acknowledgments We thank Editage (www.editage.jp) for English language editing. Ethics Approval The study was approved by the ethics committee of the Beijing Friendship Hospital, who waived the requirement for informed consent in consideration of the retrospective nature of the study. Ethics Number: 2022-P2-003-01. We confirm that all methods were performed in accordance with the relevant guidelines. References O. O. Erikitola, T. Siempis, B. Foot, D. Lockington, “The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery- a Scottish Ophthalmological Surveillance Unit study,” Eye (Lond), vol. 35, pp. 584–591, 2021. P. Karesvuo, U. Elbaz, A. Achiron, I. Hecht, K. Kaarniranta, R. Tuuminen, “Effect of cataract surgery on wet age-related macular degeneration activity,” Acta Ophthalmol , vol. 100, pp. e262–269, 2022. Y. H. Kim, B. Lee, E. Kang, J. Oh, “Clustering of eyes with age-related macular degeneration or pachychoroid spectrum diseases based on choroidal thickness profile,” Sci Rep, vol. 11, p. 4999, 2021. C. M. G. Cheung, T. Y. Y. Lai, K. Teo, P. Ruamviboonsuk, S. J. Chen, J. E. Kim, et al., “Polypoidal choroidal vasculopathy: Consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV workgroup,” Ophthalmology , vol. 128, pp. 443–452, 2021. S. Zeng, C. Liang, Y. He, Y. Chen, Q. Zhao, S. Dai, et al., “Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis.” J Ophthalmol, vol. 2018, p. 2501325, 2018. M. Burke, P. Lieu, G. Abrams, J. Boss, “Macular choroidal thickness in unilateral commotio retinae,” Retin Cases Brief Rep , vol. 15, pp. 417–420, 2021. Handzel DM, Meyer CH, Wegener A. Monitoring of central corneal thickness after phacoemulsification-comparison of statical and rotating Scheimpflug pachymetry, and spectral-domain OCT. Int J Ophthalmol , vol. 15, pp. 1266–1272, 2022. T. V. Roberts, I. C. Francis, S. Lertusumitkul, M. B. Kappagoda, M. T. Coroneo, “Primary phacoemulsification for uncontrolled angle-closure glaucoma,” J Cataract Refract Surg , vol. 26, pp. 1012–1016, 2000. C. Zuo, B. Long, X. Guo, L. Chen, X. Liu, “Effect of phacoemulsification on anterior chamber angle in eyes with medically uncontrolled filtered primary angle-closure glaucoma,” J Ophthalmol, vol. 2020, 8720450, 2020. S. Uzun, E. Pehlivan, “Evaluation of choroidal thickness changes after phacoemulsification surgery,” Clin Ophthalmol, vol. 10, pp. 1613–1615, 2016. Y. Noda, A. Ogawa, T. Toyama, T. Ueta, “Long-term increase in subfoveal choroidal thickness after surgery for senile cataracts,” Am J Ophthalmol , vol. 158, pp. 455–459.e1, 2014. L. Y. Ma, A. Rong, Y. Jiang, S. Y. Deng, “Effects of femtosecond laser-assisted cataract surgery on macular and choroidal thickness in diabetic patients,” Ophthalmol Ther , vol. 10, pp. 137–150, 2021. H. Xu, M. Chen, J. V. Forrester, N. Lois, “Cataract surgery induces retinal pro-inflammatory gene expression and protein secretion,” Invest Ophthalmol Vis Sci , vol. 52, pp. 249–255, 2011. H. Ohsugi, Y. Ikuno, Z. Ohara, H. Imamura, S. Nakakura, S. Matsuba, et al., “Changes in choroidal thickness after cataract surgery,” J Cataract Refract Surg , vol. 40, pp. 184–191, 2014. C. Yun, J. Y. Han, S. Cho, S. Y. Hwang, S. W. Kim, J. Oh, “Ocular perfusion pressure and choroidal thickness in central serous chorioretinopathy and pigment epitheliopathy,” Retina , vol. 39, pp. 143–149, 2019. Öner Rİ, Karadağ AS. Evaluation of choroidal perfusion changes in obese patients: ocular effects of insulin resistance. Arq Bras Oftalmol. Vol. 81, pp. 461–465, 2018. Sansom LT, Suter CA, McKibbin M. The association between systolic blood pressure, ocular perfusion pressure and subfoveal choroidal thickness in normal individuals. Acta Ophthalmol. vol. 94, pp. 157–158, 2016. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4765978","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":334512933,"identity":"6d2997d9-d090-47b9-bca6-4c17019e8cf9","order_by":0,"name":"Weizhen Wu","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Weizhen","middleName":"","lastName":"Wu","suffix":""},{"id":334512934,"identity":"e82ec3f0-1317-415b-8d01-48ba640e9e37","order_by":1,"name":"Songguo Li","email":"","orcid":"","institution":"Peking University","correspondingAuthor":false,"prefix":"","firstName":"Songguo","middleName":"","lastName":"Li","suffix":""},{"id":334512935,"identity":"43e4c41c-c389-4390-90f2-54664c4d9212","order_by":2,"name":"Xiaolei Zhang","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaolei","middleName":"","lastName":"Zhang","suffix":""},{"id":334512936,"identity":"3a70a562-c2c8-40b2-a9a0-a54655c221cb","order_by":3,"name":"Luping Wang","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Luping","middleName":"","lastName":"Wang","suffix":""},{"id":334512937,"identity":"d669fade-4ff8-4269-a5cd-f9afe6dab8b6","order_by":4,"name":"Hongbin Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYLACxoYDDAzsjY0PP5Cmhedws7EEaVok0tsEeIhRbXD87OEXjDvuyJtLPmxjkGCwk9NtIKTlTF6aBeOZZ4Y7Zye2PShgSDY2O0BAi9mBHDMDxrbDCQa3E9sNJBgOJG4jqOX8G6iWmwfbJHiI0nIjx/gBWMsNRiK12N94Y8bA2PbMcMOZRGAgGxDhF8n+HOMPjG135A2OH3/48EOFnRxBLUDAJv0HzjYgrBwEmIlPJqNgFIyCUTAyAQAZdEicoCRkeQAAAABJRU5ErkJggg==","orcid":"","institution":"Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hongbin","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-07-19 03:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4765978/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4765978/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40001-025-02653-w","type":"published","date":"2025-05-19T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62661649,"identity":"0ae65a72-38c5-42ab-a668-db9778c4f6d9","added_by":"auto","created_at":"2024-08-17 02:42:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":462254,"visible":true,"origin":"","legend":"\u003cp\u003eThe length of the yellow double-headed arrow is the CT at the fovea.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4765978/v1/2d8909d39c8ff1f7225cd658.png"},{"id":62661648,"identity":"103a1adb-636e-43cd-ab0e-d78828554996","added_by":"auto","created_at":"2024-08-17 02:42:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":128516,"visible":true,"origin":"","legend":"\u003cp\u003eIOP showed a gradual decrease following cataract surgery\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4765978/v1/7e051773e578c5ac22756778.png"},{"id":62661651,"identity":"985afdc9-ce45-4515-b8c1-558ee2e4ac0c","added_by":"auto","created_at":"2024-08-17 02:42:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":411320,"visible":true,"origin":"","legend":"\u003cp\u003eCT showed a gradual increase following cataract surgery\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4765978/v1/b02c0075d2d076c68aa0e626.png"},{"id":62661650,"identity":"590a639a-c038-40df-84a4-5af7a5134e8c","added_by":"auto","created_at":"2024-08-17 02:42:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":151872,"visible":true,"origin":"","legend":"\u003cp\u003eAn increase in CT was negatively correlated with a decrease in IOP.\u003c/p\u003e\n\u003cp\u003ea. SFCT and IOP; b. CT 1.5 mm nasal to the foveal and IOP; c. CT 3.0 mm nasal to the foveal and IOP; d. CT 1.5 mm temporal to the foveal and IOP; e. CT 3.0 mm temporal to the foveal and IOP. CT, choroidal thickness; SFCT, subfoveal choroidal thickness; IOP, intraocular pressure\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4765978/v1/f73d40875af02b3f564fdcc6.png"},{"id":83460618,"identity":"45b1642f-b4db-4c95-8b30-ac93cd094165","added_by":"auto","created_at":"2025-05-26 16:12:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2159737,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4765978/v1/b2135113-337f-4cad-bac5-e459ea9eeefc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Retrospective evaluation of changes in choroidal thickness after cataract surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhacoemulsification has become the most commonly used procedure for the treatment of cataracts. Studies have shown that abnormal changes in macular retinal and choroidal thickness (CT) may occur after cataract surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and lesions of the macula are one of the main causes of poor visual recovery after cataract surgery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CT varies greatly with the degree of blood vessel filling. Abnormal choroidal blood vessels and blood volume can cause many retinochoroidal diseases, such as central serous chorioretinopathy, age-related macular degeneration, and polypoidal choroidal vasculopathy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, studying changes in CT after cataract surgery will also help to further increase our understanding about the pathogenesis of macular disease, and ultimately improve postoperative vision quality.\u003c/p\u003e \u003cp\u003eIn existing clinical studies, CT after cataract surgery has only been followed-up for less than 3 months and was found to be thickened [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the mechanism of change in CT in the 6 months following cataract surgery and the time required for CT to stabilize remain unknown. Therefore, in this study, enhanced depth imaging spectral domain-optical coherence tomography (EDI SD-OCT) was used to measure the CT of the fovea and certain adjacent areas within 6 months after cataract surgery to further explore the impact of phacoemulsification on CT and provide evidence for the occurrence of clinically related diseases. Moreover, intraocular pressure (IOP) changes following cataract surgery were measured to explore the correlation between changes in CT and IOP.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information\u003c/h2\u003e \u003cp\u003eThis was a retrospective study that enrolled a total of 20 eyes from 18 patients who underwent phacoemulsification surgery from July 2016 to December 2019 at the Beijing Friendship Hospital. All patients enrolled were evaluated preoperatively. We excluded the patients with cataracts combined with other ocular complications, including glaucoma, retinal vascular disorders, diabetic retinopathy and macular degeneration. Patients with systemic chronic diseases and a history of smoking were excluded. The grade of lens opacities was determined preoperatively using the Lens Opacities Classification System III. Best-corrected visual acuity, slit-lamp examination, fundus exam, IOP, and EDI SD-OCT (Heidelberg, Germany) were performed in all patients preoperatively and 3 days, 10 days, 1 month, 3 months, and 6 months postoperatively. The study was approved by the ethics committee of the Beijing Friendship Hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eOperation method\u003c/h2\u003e \u003cp\u003eThe operations were performed by the same experienced ophthalmologist using a phacoemulsification machine (Alcon, United States). Phacoemulsification surgery was performed via a 3.0 mm clear corneal incision. An intraocular lens (Rayner, UK) was implanted; the same type and brand of lens was used in all cases. No complications occurred during the operations. All patients were prescribed postoperative antibiotic and prednisolone acetate eye drops four times daily and tapering by one drop every week for 4 weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEDI SD-OCT examination\u003c/h2\u003e \u003cp\u003eCT was defined as the vertical distance between the outer edge of the retinal pigment epithelium and the inner boundary of the sclera [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. EDI SD-OCT was used to scan the macula and measure the CT at the fovea and at points 1.5 mm and 3 mm nasal and temporal to the fovea, using the system's measuring tools (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The IOP was measured three times with an applanation tonometer, and the mean value was used in the analysis. All examinations and measurements were completed by two physicians, and the results were verified for reproducibility.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eVersion 26.0 IBM SPSS Statistics for Windows (IBM Corp., Armonk, N.Y., USA) software was used for statistical analysis. The research data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The differences between preoperative and postoperative data were compared by one-way analysis of variance. The relationship between CT and IOP changes was analyzed using Pearson correlation, and statistical significance was set as \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFor this study, we enrolled a total of 20 eyes from 18 patients (7 men, 11 women) with a mean age\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of 71.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23 years (range, 65\u0026ndash;85 years).\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003eChanges in IOP before and after cataract surgery\u003c/h2\u003e\n \u003cp\u003ePairwise comparison results of preoperative and postoperative IOP showed a gradual decrease (Fig. \u003cspan\u003e2\u003c/span\u003e), and the difference in IOP between the two groups was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of intraocular pressure\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTime after surgery\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIOP (mmHg)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e5.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\n \u003cp\u003eIOP, intraocular pressure.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\"\u003e\n \u003ch2\u003eChanges in CT following cataract surgery\u003c/h2\u003e\n \u003cp\u003ePairwise comparison of the preoperative and postoperative CT showed a gradual increase (Fig. \u003cspan\u003e3\u003c/span\u003e). The CT at the subfoveal, 1.5 mm and 3.0 mm nasal to the fovea, had statistically significant differences at different time points (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Tables \u003cspan\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eChoroidal thickness measurements before and after cataract surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubfoveal CT, \u0026micro;m\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCT 1.5 mm nasal to the fovea, \u0026micro;m\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCT 3.0 mm nasal to the fovea, \u0026micro;m\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCT 1.5 mm temporal to the fovea, \u0026micro;m\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCT 3.0 mm temporal to the fovea, \u0026micro;m\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e213.20\u0026thinsp;\u0026plusmn;\u0026thinsp;52.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173.87\u0026thinsp;\u0026plusmn;\u0026thinsp;53.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.67\u0026thinsp;\u0026plusmn;\u0026thinsp;41.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e194.53\u0026thinsp;\u0026plusmn;\u0026thinsp;55.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205.07\u0026thinsp;\u0026plusmn;\u0026thinsp;53.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 days after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e234.07\u0026thinsp;\u0026plusmn;\u0026thinsp;60.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e206.80\u0026thinsp;\u0026plusmn;\u0026thinsp;76.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e138.20\u0026thinsp;\u0026plusmn;\u0026thinsp;48.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e234.73\u0026thinsp;\u0026plusmn;\u0026thinsp;80.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e222.93\u0026thinsp;\u0026plusmn;\u0026thinsp;70.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 days after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e258.13\u0026thinsp;\u0026plusmn;\u0026thinsp;64.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e227.80\u0026thinsp;\u0026plusmn;\u0026thinsp;90.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153.33\u0026thinsp;\u0026plusmn;\u0026thinsp;44.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e238.53\u0026thinsp;\u0026plusmn;\u0026thinsp;78.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e240.87\u0026thinsp;\u0026plusmn;\u0026thinsp;59.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e264.93\u0026thinsp;\u0026plusmn;\u0026thinsp;68.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e244.53\u0026thinsp;\u0026plusmn;\u0026thinsp;99.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169.40\u0026thinsp;\u0026plusmn;\u0026thinsp;52.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e244.47\u0026thinsp;\u0026plusmn;\u0026thinsp;85.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e250.80\u0026thinsp;\u0026plusmn;\u0026thinsp;64.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e274.87\u0026thinsp;\u0026plusmn;\u0026thinsp;63.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e271.27\u0026thinsp;\u0026plusmn;\u0026thinsp;85.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178.80\u0026thinsp;\u0026plusmn;\u0026thinsp;35.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e260.67\u0026thinsp;\u0026plusmn;\u0026thinsp;83.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e263.67\u0026thinsp;\u0026plusmn;\u0026thinsp;80.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e288.87\u0026thinsp;\u0026plusmn;\u0026thinsp;67.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e289.53\u0026thinsp;\u0026plusmn;\u0026thinsp;86.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e211.47\u0026thinsp;\u0026plusmn;\u0026thinsp;47.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e269.20\u0026thinsp;\u0026plusmn;\u0026thinsp;80.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e276.00\u0026thinsp;\u0026plusmn;\u0026thinsp;84.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\n \u003cp\u003eCT, choroidal thickness.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eCorrelation between decrease in IOP and change in CT at different time points after surgery\u003c/h2\u003e\n \u003cp\u003eWithin 6 months after cataract surgery, the increase in CT at all regions measured by EDI SD-OCT was negatively correlated with the decrease in IOP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table \u003cspan\u003e3\u003c/span\u003e and Fig. 4; meanwhile, there were no statistically significant changes in CT and IOP within the first postoperative month (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCorrelation between changes in intraocular pressure and choroidal thickness within 6 months following cataract surgery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eChange in IOP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSubfoveal CT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT 1.5 mm nasal to the foveal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT 3.0 mm nasal to the foveal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT 1.5 mm temporal to the foveal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCT 3.0 mm temporal to the foveal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eCT, choroidal thickness; IOP, intraocular pressure.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study show that IOP gradually decreased for 6 months after cataract surgery, reaching the lowest value at the end of this period. Handzel et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] have found that corneal thickening can occur in the short term after cataract surgery. Although corneal thickening can lead to high IOP measurements, the multiple factors that cause IOP to drop are much greater than the effect of corneal thickness on IOP. This may be related to the removal of the compression on Schlemm\u0026rsquo;s canal, and the trabecular meshwork caused by the cataractous lens. In addition, the use of viscoelastic agents and continuous infusion of fluid into the anterior chamber during the operation plays a role in openin\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eg\u003c/span\u003e the anterior chamber angle, thereby deepening the anterior chamber after the operation and causing a trend toward a further decrease in IOP. As early as 1945, a study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] had proposed the theory that cataract surgery would cause a drop in IOP. Cataract surgery can also reduce the secretory function of the ciliary body, an increase in the release of endogenous prostaglandins, and changes in the postoperative blood-aqueous barrier function, all of which can lead to a decrease in postoperative IOP [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. From this study, it is evident that the gradual decrease in IOP after cataract surgery is statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn this study, statistically significant changes were observed in CT after cataract surgery. The CT increased gradually starting three days after surgery and peaked six months postoperatively. However, the increase in CT varied among the anatomical regions measured. The mechanism of and factors influencing the changes in CT after cataract surgery remain unclear [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Clinical studies have shown that the CT of the macular fovea preoperatively and postoperatively are significantly correlated with each other, while the changes in CT are not significantly correlated with age, axial length, or surgery duration [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We speculate that surgical mechanical damage and ultrasound energy cause the release of a large amount of inflammatory mediators, which destroy the blood-retinal barrier, leading to increased vascular permeability, and ultimately, to choroidal thickening. Research [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] has found that femtosecond laser-assisted cataract surgery has less impact on choroidal function than traditional surgery. It also showed that reducing mechanical manipulations during surgery can reduce the release of inflammatory factors and prostaglandins, thereby reducing damage to the blood-retinal barrier [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Under normal circumstances, the inflammatory response after cataract surgery lasts for about one month, but the results from this study showed that the CT gradually increased for 6 months after cataract surgery, demonstrating that there are other factors that affect the changes in CT. Some scholars believe that the expression of specific genes after cataract surgery can also cause changes in choroidal function. Related animal experiments have shown that extracapsular lens removal can cause a significant increase in the gene expression of vascular endothelial growth factor and fibroblast growth factor in the choroid. Thus, the permeability of the choroidal capillaries increases, which leads to thickening of the choroid [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy statistically analyzing the relationship between the changes in CT at different anatomical regions after cataract surgery and with the decrease in IOP, we found that within 6 months after the operation, the increase in CT at the five measurement regions and the decrease in IOP were significantly negatively correlated. However, within one month after surgery, the changes in CT and IOP were not statistically significant. It is speculated that the increase in macular foveal CT at 3 months and 6 months after cataract surgery may be related to the increase in ocular perfusion pressure caused by the drop in IOP after cataract surgery. Various factors, including the increase of intraocular inflammatory mediators and prostaglandins, and the use of local drugs within a month after surgery, may influence the IOP and choroidal capillary blood flow; therefore, there is no statistical relationship between the changes in CT and IOP within a month after surgery. The study by Ohsugi et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]showed that the changes in the SFCT and IOP after cataract surgery were significantly negatively correlated. Many studies have shown that the increase in macular CT is significantly related to ocular perfusion pressure [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and the measurement of CT in the macular area may indirectly indicate the perfusion state of the blood vessels in the macular area. Therefore, studying the changes in CT after cataract surgery will also play a role in the diagnosis and treatment of macular diseases.\u003c/p\u003e \u003cp\u003eIn existing clinical studies, the postoperative follow-up time is generally less than 3 months, but the present study followed-up with patients for up to 6 months after surgery and found that CT had still not stabilized. Our data clearly show the trends in CT changes within 6 months after cataract surgery. Due to the small sample size, the reliability of data in our study may be limited.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, statistical analysis of changes in CT evaluated by EDI SD-OCT and IOP after cataract surgery via phacoemulsification will help deepen the understanding of fundus diseases associated with cataract surgery and will also play a guiding role in solving clinical complications. In future research, we will expand the sample size, extend the follow-up time, add more variables or control groups, and conduct further research and analysis on the changes in CT after cataract surgery.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data supporting the conclusions of this article are included within the article.\u003c/p\u003e\n\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\n\u003cp\u003eThe author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.\u003c/p\u003e\n\u003ch2\u003eFunding Statement\u003c/h2\u003e\n\u003cp\u003eNo Funding.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Acknowledgments\u003c/p\u003e\n\u003cp\u003eWe thank Editage (www.editage.jp) for English language editing.\u003c/p\u003e\n\u003ch2\u003eEthics Approval\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the ethics committee of the Beijing Friendship Hospital, who waived the requirement for informed consent in consideration of the retrospective nature of the study. Ethics Number: 2022-P2-003-01. We confirm that all methods were performed in accordance with the relevant guidelines.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eO. O. Erikitola, T. Siempis, B. Foot, D. Lockington, \u0026ldquo;The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery- a Scottish Ophthalmological Surveillance Unit study,\u0026rdquo; \u003cem\u003eEye (Lond),\u003c/em\u003e vol. 35, pp. 584\u0026ndash;591, 2021.\u003c/li\u003e\n\u003cli\u003eP. Karesvuo, U. Elbaz, A. Achiron, I. Hecht, K. Kaarniranta, R. Tuuminen, \u0026ldquo;Effect of cataract surgery on wet age-related macular degeneration activity,\u0026rdquo; \u003cem\u003eActa Ophthalmol\u003c/em\u003e, vol. 100, pp. e262\u0026ndash;269, 2022.\u003c/li\u003e\n\u003cli\u003eY. H. Kim, B. Lee, E. Kang, J. Oh, \u0026ldquo;Clustering of eyes with age-related macular degeneration or pachychoroid spectrum diseases based on choroidal thickness profile,\u0026rdquo; \u003cem\u003eSci Rep,\u003c/em\u003e vol. 11, p. 4999, 2021.\u003c/li\u003e\n\u003cli\u003eC. M. G. Cheung, T. Y. Y. Lai, K. Teo, P. Ruamviboonsuk, S. J. Chen, J. E. Kim, et al., \u0026ldquo;Polypoidal choroidal vasculopathy: Consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV workgroup,\u0026rdquo; \u003cem\u003eOphthalmology\u003c/em\u003e, vol. 128, pp. 443\u0026ndash;452, 2021.\u003c/li\u003e\n\u003cli\u003eS. Zeng, C. Liang, Y. He, Y. Chen, Q. Zhao, S. Dai, et al., \u0026ldquo;Changes of Subfoveal Choroidal Thickness after Cataract Surgery: A Meta-Analysis.\u0026rdquo; \u003cem\u003eJ Ophthalmol,\u003c/em\u003e vol. 2018, p. 2501325, 2018.\u003c/li\u003e\n\u003cli\u003eM. Burke, P. Lieu, G. Abrams, J. Boss, \u0026ldquo;Macular choroidal thickness in unilateral commotio retinae,\u0026rdquo; \u003cem\u003eRetin Cases Brief Rep\u003c/em\u003e, vol. 15, pp. 417\u0026ndash;420, 2021.\u003c/li\u003e\n\u003cli\u003eHandzel DM, Meyer CH, Wegener A. Monitoring of central corneal thickness after phacoemulsification-comparison of statical and rotating Scheimpflug pachymetry, and spectral-domain OCT.\u003cem\u003e Int J Ophthalmol\u003c/em\u003e, vol. 15, pp. 1266\u0026ndash;1272, 2022.\u003c/li\u003e\n\u003cli\u003eT. V. Roberts, I. C. Francis, S. Lertusumitkul, M. B. Kappagoda, M. T. Coroneo, \u0026ldquo;Primary phacoemulsification for uncontrolled angle-closure glaucoma,\u0026rdquo; \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e, vol. 26, pp. 1012\u0026ndash;1016, 2000.\u003c/li\u003e\n\u003cli\u003eC. Zuo, B. Long, X. Guo, L. Chen, X. Liu, \u0026ldquo;Effect of phacoemulsification on anterior chamber angle in eyes with medically uncontrolled filtered primary angle-closure glaucoma,\u0026rdquo; \u003cem\u003eJ Ophthalmol,\u003c/em\u003e vol. 2020, 8720450, 2020.\u003c/li\u003e\n\u003cli\u003eS. Uzun, E. Pehlivan, \u0026ldquo;Evaluation of choroidal thickness changes after phacoemulsification surgery,\u0026rdquo; \u003cem\u003eClin Ophthalmol,\u003c/em\u003e vol. 10, pp. 1613\u0026ndash;1615, 2016.\u003c/li\u003e\n\u003cli\u003eY. Noda, A. Ogawa, T. Toyama, T. Ueta, \u0026ldquo;Long-term increase in subfoveal choroidal thickness after surgery for senile cataracts,\u0026rdquo; \u003cem\u003eAm J Ophthalmol\u003c/em\u003e, vol. 158, pp. 455\u0026ndash;459.e1, 2014.\u003c/li\u003e\n\u003cli\u003eL. Y. Ma, A. Rong, Y. Jiang, S. Y. Deng, \u0026ldquo;Effects of femtosecond laser-assisted cataract surgery on macular and choroidal thickness in diabetic patients,\u0026rdquo; \u003cem\u003eOphthalmol Ther\u003c/em\u003e, vol. 10, pp. 137\u0026ndash;150, 2021.\u003c/li\u003e\n\u003cli\u003eH. Xu, M. Chen, J. V. Forrester, N. Lois, \u0026ldquo;Cataract surgery induces retinal pro-inflammatory gene expression and protein secretion,\u0026rdquo; \u003cem\u003eInvest Ophthalmol Vis Sci\u003c/em\u003e, vol. 52, pp. 249\u0026ndash;255, 2011.\u003c/li\u003e\n\u003cli\u003eH. Ohsugi, Y. Ikuno, Z. Ohara, H. Imamura, S. Nakakura, S. Matsuba, et al., \u0026ldquo;Changes in choroidal thickness after cataract surgery,\u0026rdquo;\u003cem\u003e J Cataract Refract Surg\u003c/em\u003e, vol. 40, pp. 184\u0026ndash;191, 2014.\u003c/li\u003e\n\u003cli\u003eC. Yun, J. Y. Han, S. Cho, S. Y. Hwang, S. W. Kim, J. Oh, \u0026ldquo;Ocular perfusion pressure and choroidal thickness in central serous chorioretinopathy and pigment epitheliopathy,\u0026rdquo; \u003cem\u003eRetina\u003c/em\u003e, vol. 39, pp. 143\u0026ndash;149, 2019.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;ner Rİ, Karadağ AS. Evaluation of choroidal perfusion changes in obese patients: ocular effects of insulin resistance. Arq Bras Oftalmol. Vol. 81, pp. 461\u0026ndash;465, 2018.\u003c/li\u003e\n\u003cli\u003eSansom LT, Suter CA, McKibbin M. The association between systolic blood pressure, ocular perfusion pressure and subfoveal choroidal thickness in normal individuals. Acta Ophthalmol. vol. 94, pp. 157\u0026ndash;158, 2016. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"choroidal thickness, intraocular pressure, cataract surgery, enhanced depth imaging spectral domain-optical coherence tomography","lastPublishedDoi":"10.21203/rs.3.rs-4765978/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4765978/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn this retrospective study, we investigated the changes in choroidal thickness (CT) using enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) and intraocular pressure (IOP) following phacoemulsification. Twenty eyes of 18 patients who underwent phacoemulsification and intraocular lens implantation were included in this study. All patients underwent a detailed ophthalmologic examination. Enhanced depth imaging spectral domain-optical coherence tomography was used to measure CT preoperatively, and postoperatively at days three and ten, and months one, three, and six. CT was measured at the fovea and at points 1.5 mm and 3.0 mm nasal and temporal to the fovea. The data were compared using one-way analysis of variance. The correlation between the changes in the CT and IOP in all sectors was analyzed. There were statistically significant changes in CT and IOP after cataract surgery (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The IOP reached a minimum (10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64 mmHg) at six months postoperatively. CT increased at the fovea, 1.5 mm and 3 mm nasal to the fovea postoperatively, and gradually thickened over time, reaching a peak (288.87\u0026thinsp;\u0026plusmn;\u0026thinsp;67.70 \u0026micro;m) at six months postoperatively. The CT increase was negatively correlated with the decrease in IOP within six months after surgery (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Our study demonstrated that after cataract surgery, the IOP decreased and the choroid thickened, lasting up to 6 months. Studying the changes in CT and IOP after cataract surgery will help deepen the understanding of fundus diseases associated with cataract surgery and will also play a guiding role in solving clinical complications.\u003c/p\u003e","manuscriptTitle":"Retrospective evaluation of changes in choroidal thickness after cataract surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 02:42:15","doi":"10.21203/rs.3.rs-4765978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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