Retinal Vascular Changes in Optical Coherence Tomography Angiography of Highly Myopic Patients Undergoing Uncomplicated Cataract Surgery

Retinal Vascular Changes in Optical Coherence Tomography Angiography of Highly Myopic Patients Undergoing Uncomplicated 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 Retinal Vascular Changes in Optical Coherence Tomography Angiography of Highly Myopic Patients Undergoing Uncomplicated Cataract Surgery Mehmet Egemen Karataş, Dilek Güven, Mehmet Demir, Semra Tiryaki Demir This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8277380/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To investigate long-term structural changes in the retina of highly myopic patients following uncomplicated cataract surgery using optical coherence tomography angiography (OCTA). Methods This cross-sectional, observational study included 61 eyes of 37 highly myopic patients who underwent uncomplicated cataract surgery as the study group and 71 eyes of 42 highly myopic patients under clinical follow-up as the control group. Retinal vascular structures in the macular regions were examined in detail and quantitatively assessed using OCT and OCTA. Data from these two groups were compared. Results There were no statistically significant differences between the groups in terms of age, sex, best corrected visual acuity, or axial length. The mean duration between cataract surgery and OCTA imaging in the study group was 18.2 months. A statistically significant decrease in microvascular vessel density was observed in all quadrants of the foveal and parafoveal areas in the study group (p < 0.05). However, no significant difference was found in the foveal avascular zone area between the groups (p = 0.267). Conclusions In highly myopic patients undergoing uncomplicated cataract surgery, long-term macular vessel density was reduced compared to the control group. Our study is significant as it is the first to assess retinal vascular structural changes in cataract-operated highly myopic patients with a control group consisting of highly myopic individuals. Furthermore, this study provides a valuable perspective for cases where postoperative visual decline cannot be explained despite the absence of complications. Cataract high myopia macula optical coherence tomography angiography INTRODUCTION Myopia is one of the leading causes of visual impairment worldwide and has reached epidemic levels in some countries [ 1 ]. High myopia is a significant global public health concern, and as of 2023, it has been shown to affect approximately 4% of the population (13 million people) in the United States [ 2 ]. It is estimated that the number of people experiencing vision loss due to high myopia may increase sevenfold from 2000 to 2050, making myopia the leading cause of permanent blindness worldwide [ 3 ]. High myopia is characterized by severe anatomical changes in the retina that limit the best corrected visual acuity (BCVA), which can lead to complications resulting in blindness [ 4 ]. In high myopia, refractive error is ≥ -6 diopters (D), and axial length of the eye is ≥ 26 mm. Findings of myopic degeneration include vitreous liquefaction, posterior vitreous detachment, retinal pigment epithelium thinning, prominence of choroidal vessels, peripheral retinal degenerations, retinal detachment (RD), lacquer cracks in Bruch’s membrane, choroidal neovascularization (CNV), Fuchs spot, macular hole (MH), optic disc changes, posterior staphyloma, crescent formation, chorioretinal atrophy, and macular atrophy [ 5 ]. Optical coherence tomography angiography (OCTA) is an emerging diagnostic tool in clinical practice that utilizes infrared wavelengths to provide non-invasive, high-resolution imaging of the retinal microvascular structure [ 6 ]. Recent advancements in OCTA technology have enabled the mapping of ocular circulation at the capillary level. OCTA holds great potential for measuring microvascular changes in response to physiological and pathological alterations. With the rapid increase in the myopic population, cataract surgery has also become more common in individuals with high myopia. However, performing cataract surgery in highly myopic individuals poses greater surgical risks and a more complex procedure, often resulting in less favorable postoperative outcomes. When making surgical decisions, both the surgeon and the patient should thoroughly evaluate the benefits and risks of the surgery and determine the most appropriate timing for the procedure. With proper patient selection, phacoemulsification surgery is frequently preferred for cataracts in highly myopic patients due to its good visual acuity outcomes, low complication rates, high predictability, and stability [ 7 ]. This study aims to investigate degenerative abnormalities in patients diagnosed with high myopia who underwent cataract surgery using OCTA imaging, to determine and compare the effects on the macula. Through these comparisons, we intend to elucidate how retinal vascular structures are affected following cataract surgery in high myopia patients and to establish a database for future studies. METHODS This cross-sectional, prospective observational study was reviewed and approved by the Clinical Research Ethics Committee of Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, with number 2640. All patients had provided informed written consent. This trial was conducted in accordance with the tenets of the Declaration of Helsinki. The data that support the findings of this study are available from the corresponding author, on reasonable request. A total of 79 patients followed in the Ophthalmology Department at Şişli Hamidiye Etfal Training and Research Hospital between 2019 and 2024, who had a high myopia diagnosis with a refractive error of ≥ -6.0 D or an axial length of ≥ 26 mm, and met the inclusion criteria, were included in the study. The control group consisted of 71 eyes from 42 patients under clinical follow-up for high myopia alone, while the study group comprised 61 eyes from 37 patients with high myopia who had undergone cataract surgery (phacoemulsification). All patients in the control group were phakic, and all patients in the study group were pseudophakic. The exclusion criteria were patients younger than 40 years, who could not maintain fixation required for imaging due to poor visual acuity, with any anterior or posterior segment pathology affecting imaging quality (such as corneal opacity, vitreous opacity, or vitreous hemorrhage), systemic diseases affecting macular function (such as diabetes mellitus, chronic obstructive pulmonary disease, or congestive heart failure), with a history of systemic medication use, additional ocular diseases other than myopia (such as diabetic retinopathy, hypertensive retinopathy, glaucoma, or uveitis), with poor image quality (signal strength index < 6/10), with a history of ocular surgery, including cataract surgery, within the last six months, and those who had undergone complicated cataract surgery. The gender, age, laterality, and lens status of all included patients were recorded. Refractive measurements were performed using an autorefractometer (Canon RK-F1 Auto Ref-Keratometer, Tokyo, Japan). The spherical equivalent of the refractive error was calculated using the formula: Spherical equivalent = Spherical value + (Cylindrical value/2). The BCVA was determined using the Snellen chart and converted to Logarithm of the Minimum Angle of Resolution (logMAR) equivalents. Axial length measurements were obtained using optical biometry (AL-Scan, Nidek Co, Ltd., Gamagori, Japan). Spectral-domain OCT imaging (AngioVue, Optovue, Fremont, CA) was performed after pupil dilatation (using tropicamide 0.5% and phenylephrine 2.5% eye drops). All of OCT scans were performed by the same retina specialist (M.E.K), during the same time interval of the day (between 10:00 A.M. and 2:00 P.M.). The foveal center was defined as the location at which the foveal pit is deepest. Central macular thickness (CMT) was measured using the Retina Map mode of OCTA, and subfoveal choroidal thickness (SFCT) was manually measured in the HD (High Definition) Line mode. While CMT was automatically provided by the device, SFCT was manually measured using the caliper tool, defined as the perpendicular distance between the outer boundary of the hyperreflective retinal pigment epithelium (RPE)-Bruch's membrane complex and the outer boundary of the large choroidal vessels extending to the scleral hyperreflectivity. To exclude diurnal variations, all examinations were performed at the same time of day. Macular imaging with OCTA was performed using a scan of 3 × 3 mm centered on the fovea (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). In the central macula, the superficial foveal avascular zone (FAZ) area, as well as the vascular densities (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), were evaluated. The VD of SCP and DCP were analyzed in subregions, including the whole scan area, fovea, parafoveal region, temporal quadrant, superior quadrant, nasal quadrant, and inferior quadrant. The foveal avascular zone (FAZ) is an area on the central fovea that is free from retinal capillaries. The FAZ area (in mm2) was determined from the en face OCTA images. The FAZ diameter was automatically calculated using the nonflow mode in each image of the auto-segmented retina. All of the OCTA images reviewed to ensure the correct segmentation and identify poor-quality scans with motion artifacts or blurred images, or where the data were insufficient for proper analysis. The device included the projection artifact removal algorithm. The SCP was automatically measured by the device between 3 microns below the internal limiting membrane (ILM) and 15 microns below the inner plexiform layer. The DCP was automatically measured by the device from 15 microns below the inner plexiform layer to 70 microns beneath. Using the algorithm in the device software, VD (%) in SCP and DCP was measured within areas divided by 1 mm and 3 mm diameter circles centered on the FAZ (foveal and parafoveal regions). In descriptive statistics, categorical variables were presented as counts and percentages, while continuous variables were expressed as mean ± standard deviation, median (minimum–maximum values), ratio, and frequency. The normality of continuous variables was assessed using the Kolmogorov-Smirnov or Shapiro-Wilk test. The chi-square test was used to compare categorical variables between groups, and Fisher’s exact test was applied when chi-square test assumptions were not met. The Mann-Whitney U test was used for non-normally distributed continuous variables, while the independent samples t-test was used for normally distributed continuous variables. To account for the correlation between eyes from the same patient, statistical analyses were performed using Generalized Estimating Equations (GEE) models. For statistical analysis, SPSS 27.0 (IBM Corp., Armonk, NY, USA) statistical software package was used. The correlation between OCTA vascular density measurements and the age and axial length values of high myopia patients was analyzed using Pearson’s correlation test for normally distributed data and Spearman’s correlation test for non-normally distributed data. A p-value of < 0.05 was considered statistically significant. RESULTS The control group consisted of 14 (33.3%) male and 28 (66.6%) female patients, while the study group included 12 (32.4%) male and 25 (67.6%) female patients. A total of 71 eyes from 42 patients in the control group and 61 eyes from 37 patients in the study group were included in the analysis. The mean age was 64.6 ± 9.9 years in the control group and 65.8 ± 10.4 years in the study group. The mean duration between cataract surgery and OCTA imaging in the study group was 18.2 ± 4.3 months. The age, gender, BCVA, spherical equivalent, axial length and CMT values for both groups are presented in Table 1 . Table 1 Distribution of age, gender, best corrected visual acuity (BCVA), spherical equivalent, axial length, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) in both groups. Parameters Control Group Study Group p value Age (years), mean ± SD 64.6 ± 9.9 65.8 ± 10.4 0.103 Gender, Female/Male, (n) 28/14 25/12 0.741 BCVA (LogMar), mean ± SD 0.33 ± 0.67 0.38 ± 0.49 0.08 Spherical Equivalent (D), mean ± SD -8.52 ± 4.82 -1.91 ± 3.42 < 0.001* AL (mm), mean ± SD 28.97 ± 1.7 29.27 ± 1.9 0.126 CMT (µm), mean ± SD 164.12 ± 33.68 162.36 ± 52.85 0.224 SFCT (µm), mean ± SD 147.57 ± 53.07 137.40 ± 36.93 0.108 AL: Axial length, BCVA: Best corrected visual acuity, CMT: Central macular thickness, SFCT: Subfoveal choroidal thickness * Statistically significant The mean FAZ area and VD values in different macular regions for both groups are presented in Table 2 . Compared to the control group, the study group showed significantly lower mean VD values across all quadrants (p < 0.05). Table 2 OCTA superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DCP-VD), and foveal avascular zone (FAZ) area values in both groups. Parameters Control Group (mean ± SD) Study Group (mean ± SD) p value Whole image SCP-VD (%) 40.98 ± 4.98 37.27 ± 5 < 0.001* Foveal SCP-VD (%) 19.52 ± 5.63 18.25 ± 6.25 0.014* Parafoveal SCP-VD (%) 43,67 ± 5.14 39.98 ± 5.31 < 0.001* Parafoveal temporal SCP-VD (%) 42.92 ± 4.46 39.44 ± 6.49 < 0.001* Parafoveal superior SCP-VD (%) 45.66 ± 5.65 40.97 ± 6.54 < 0.001* Parafoveal nasal SCP-VD (%) 42.85 ± 6.60 38.57 ± 5.51 < 0.001* Parafoveal inferior SCP-VD (%) 42.96 ± 6.64 39.58 ± 6.52 < 0.001* Whole image DCP-VD (%) 48.35 ± 4.96 42.60 ± 5.05 < 0.001* Foveal DCP-VD (%) 34.66 ± 6.65 30.03 ± 8.09 < 0.001* Parafoveal DCP-VD (%) 50.77 ± 5.25 45.38 ± 5.50 < 0.001* Parafoveal temporal DCP-VD (%) 52.15 ± 5.44 45.30 ± 5.70 < 0.001* Parafoveal superior DCP-VD (%) 50.17 ± 5.85 45.13 ± 5.54 < 0.001* Parafoveal nasal DCP-VD (%) 50 ± 5.91 45.16 ± 6.19 < 0.001* Parafoveal inferior DCP-VD (%) 50.34 ± 5.98 44.23 ± 6.42 < 0.001* FAZ (mm2) 0.25 ± 0.98 0.26 ± 0.93 0.267 DCP: Deep capillary plexus, FAZ: Foveal avascular zone, SCP: Superficial capillary plexus, VD: Vessel density * Statistically significant A positive correlation was found between age and axial length with visual acuity (logMAR), whereas a negative correlation was observed between these parameters and CMT, SFCT and OCTA vascular parameters. The detailed correlation analysis is presented in Table 3 . Table 3 Correlation of age and axial length values with best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and OCTA parameters. Parameters Age Axial Length r value p value r value p value BCVA (logMAR) 0.186 0.032* 0.291 0.001* Central macular thickness -0.284 0.001* -0.219 0.012* Subfoveal choroidal thickness -0.190 0.029* -0.335 0.000* Whole image SCP-VD -0.255 0.003* -0.277 0.001* Foveal SCP-VD -0.267 0.002* -0.075 0.390 Parafoveal SCP-VD -0.225 0.010* -0.287 0.001* Parafoveal temporal SCP-VD -0.134 0.126 -0.292 0.001* Parafoveal superior SCP-VD -0.261 0.003* -0.310 0.000* Parafoveal nasal SCP-VD -0.222 0.011* -0.224 0.010* Parafoveal inferior SCP-VD -0.149 0.088 -0.236 0.006* Whole image DCP-VD -0.324 0.000* -0.344 0.000* Foveal DCP-VD -0.299 0.000* -0.095 0.278 Parafoveal DCP-VD -0.263 0.002* -0.328 0.000* Parafoveal temporal DCP-VD -0.261 0.002* -0.365 0.000* Parafoveal superior DCP-VD -0.282 0.001* -0.319 0.000* Parafoveal nasal DCP-VD -0.301 0.000* -0.297 0.001* Parafoveal inferior DCP-VD -0.274 0.001* -0.348 0.000* Foveal avascular zone 0.123 0.161 -0.031 0.722 BCVA: Best corrected visual acuity, DCP: Deep capillary plexus, SCP: Superficial capillary plexus, VD: Vessel density * Statistically significant DISCUSSION This study was conducted to investigate the retinal microvascular status following phacoemulsification surgery in highly myopic patients. To our knowledge, it is the largest prospective study with the longest single-center follow-up period (18.2 months) in the current literature. No other study has evaluated long-term postoperative outcomes in high myopia with a control group consisting of highly myopic patients. A previous study involving 38 eyes compared OCTA findings before and at 1 day, 1 week, 1 month, and 3–6 months after phacoemulsification between a high myopia group (axial length > 26.5 mm) and a control group (22 mm < axial length ≤ 24.5 mm). The mean changes in macular vessel density (VD) were significantly higher in high myopic patients on the first postoperative day compared to the control group [ 8 ]. Another study, including 55 eyes, evaluated OCTA findings in high myopia and low myopia groups before and at 1 day, 1 week, 1 month, and 3 months after surgery. Although macular VD values increased in the high myopia group at 1 week and 1 month postoperatively, they were significantly lower at 3 months compared to preoperative levels [ 9 ]. In our study, at an average follow-up of 18.2 months, VD values in the SCP and DCP were lower in all macular quadrants in the high myopia group compared to the control group. Early postoperative increases in VD may be attributed to inflammation; however, our study demonstrates that in the long-term postoperative period, after inflammation has resolved, VD values continue to decrease. Additionally, our control group consisted of highly myopic patients without prior surgery, and our sample size is considerably larger than these studies, further supporting the robustness and reliability of our findings. We believe our results provide a more accurate and reliable assessment of the effects of phacoemulsification surgery in high myopia. In a study by Liu et al. involving 58 eyes with normal axial length, perifoveal DCP VD significantly increased at 1 month postoperatively compared to preoperative OCTA findings, but this effect disappeared at 3 months [ 10 ]. Similarly, Pilotto et al. reported an increase in intermediate capillary plexus (ICP) and DCP perfusion 1 day after uncomplicated cataract surgery, while SCP perfusion remained unchanged. By 90 days, all parameters had returned to baseline levels, which the authors attributed to the inflammatory nature of the surgery [ 11 ]. Our study did not assess early postoperative changes; however, we found a persistent decrease in VD in all quadrants in the high myopia group compared to controls in the long term. It is possible that highly myopic eyes are more vulnerable to surgical stimulation, which may lead to permanent retinal microvascular alterations through mechanisms such as local inflammation, ultrasound energy, perfusion fluid toxicity, or light exposure. A study comparing diabetic and non-diabetic patients undergoing cataract surgery found that SCP VD was significantly higher in the diabetic group at 3 months postoperatively [ 12 ]. This suggests that diabetic eyes, like highly myopic eyes, may experience prolonged or even permanent vascular changes due to surgical trauma and inflammation. Since diabetes is an inflammatory disease, surgery-induced inflammation may result in a persistent VD increase. In contrast, high myopia is a condition prone to atrophy; thus, a long-term VD reduction following surgery is inevitable. Although our study findings differ, the distinct pathophysiologies of these conditions support the hypothesis that long-term changes in VD may be permanent. Previous studies comparing FAZ areas between high myopia and normal axial length groups found no significant differences [ 13 ]. Similarly, another study found no significant difference in FAZ area in diabetic and non-diabetic patients within the first 3 months after uncomplicated cataract surgery [ 12 ]. Additionally, OCTA imaging before and 2 weeks after cardiopulmonary bypass surgery revealed no significant change in FAZ area [ 14 ]. Consistent with the literature, our study also found no significant difference in FAZ area between the two groups. The lack of difference in FAZ area across studies with varying axial lengths and systemic conditions reinforces our finding that FAZ remains unaffected within a homogeneous disease group. A study investigating long-term (12-month) changes in SFCT after cataract surgery found no significant difference compared to preoperative values [ 15 ]. The same study suggested that uncomplicated phacoemulsification might cause subclinical changes in CMT, likely due to surgical inflammation, but that CMT eventually returned to baseline. Similarly, our study found no significant long-term differences in CMT and SFCT between highly myopic eyes with and without cataract surgery. Fan et al. evaluated participants under 40 years old with different refractive statuses and found a negative correlation between axial length and macular VD using OCTA [ 16 ]. Our study also demonstrated a negative correlation between axial length and OCTA parameters, supporting these findings. The limitations of this study include the absence of early postoperative data before and after phacoemulsification. However, we addressed this limitation with a prospective study design, a large sample size, and a control group consisting of highly myopic patients. Additionally, the use of a single center, a single device for data collection, and automated device-generated measurements enhance the reliability of our results. In conclusion, we demonstrated that, in highly myopic patients, long-term microvascular structures and flow parameters in the macular region are affected after cataract surgery, while the FAZ area remains unchanged. The decreased VD values in the macula in the long-term postoperative period may be a potential prognostic indicator in highly myopic cataract patients; however, the clinical significance of these findings remains unclear. Further longitudinal studies with larger patient cohorts and more frequent follow-up intervals are warranted to elucidate whether these changes translate into meaningful functional outcomes. Declarations Conflicts of Interest The authors declare that they have no conflict of interest. All authors have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Written informed consent was obtained from all participants. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Clinical Research Ethics Committee of Şişli Hamidiye Etfal Training and Research Hospital. (2020/No 2640). Consent to participate Informed consent was obtained from all individual participants included in the study. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution All authors contributed to the study conception and design.Material preparation, data collection and analysis were performed by [Mehmet Egemen Karataş], [Dilek Güven], [Mehmet Demir], [Semra Tiryaki Demir] The first draft of the manuscript was written by [Mehmet Egemen Karataş] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Flaxman, S. R., Bourne, R. R., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., ... & Zheng, Y. (2017). Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. The Lancet Global Health, 5(12), e1221-e1234. Banashefski B, Rhee MK, Lema GMC. High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review. J Clin Med . 2023;12(8):3045. 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Indian J Ophthalmol . 2024;72(Suppl 1):S119-S124. doi:10.4103/IJO.IJO_2800_22. Yılmaz T, Karci AA, Yilmaz İ, Yılmaz A, Yıldırım Y, Sakalar YB. Long-Term Changes in Subfoveal Choroidal Thickness After Cataract Surgery. Med Sci Monit . 2016;22:1566-1570. Published 2016 May 9. doi:10.12659/msm.898714. Fan H, Chen HY, Ma HJ, Chang Z, Yin HQ, Ng DS, Cheung CY, Hu S, Xiang X, Tang SB, Li SN. Reduced macular vascular density in myopic eyes. Chin Med J (Engl) 2017;130:445–451. doi: 10.4103/0366-6999.199844. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-8277380","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571731295,"identity":"9cac5cca-8ed3-46c0-8729-d5bd69233a24","order_by":0,"name":"Mehmet Egemen 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09:23:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8277380/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8277380/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99866582,"identity":"e3426b9f-b503-4849-a0ec-2880ba496ced","added_by":"auto","created_at":"2026-01-09 08:18:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33677,"visible":true,"origin":"","legend":"","description":"","filename":"MainManuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-8277380/v1/1495ebc28ec529ef8423733e.docx"},{"id":100358018,"identity":"8fe76524-7dd3-48a9-a322-2c0f301eea8a","added_by":"auto","created_at":"2026-01-16 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11:54:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":593447,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8277380/v1/498be9ce-ff11-4f10-a216-b0498e4ff9c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRetinal Vascular Changes in Optical Coherence Tomography Angiography of Highly Myopic Patients Undergoing Uncomplicated Cataract Surgery \u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMyopia is one of the leading causes of visual impairment worldwide and has reached epidemic levels in some countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. High myopia is a significant global public health concern, and as of 2023, it has been shown to affect approximately 4% of the population (13\u0026nbsp;million people) in the United States [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is estimated that the number of people experiencing vision loss due to high myopia may increase sevenfold from 2000 to 2050, making myopia the leading cause of permanent blindness worldwide [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. High myopia is characterized by severe anatomical changes in the retina that limit the best corrected visual acuity (BCVA), which can lead to complications resulting in blindness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn high myopia, refractive error is \u0026ge; -6 diopters (D), and axial length of the eye is \u0026ge;\u0026thinsp;26 mm. Findings of myopic degeneration include vitreous liquefaction, posterior vitreous detachment, retinal pigment epithelium thinning, prominence of choroidal vessels, peripheral retinal degenerations, retinal detachment (RD), lacquer cracks in Bruch\u0026rsquo;s membrane, choroidal neovascularization (CNV), Fuchs spot, macular hole (MH), optic disc changes, posterior staphyloma, crescent formation, chorioretinal atrophy, and macular atrophy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOptical coherence tomography angiography (OCTA) is an emerging diagnostic tool in clinical practice that utilizes infrared wavelengths to provide non-invasive, high-resolution imaging of the retinal microvascular structure [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Recent advancements in OCTA technology have enabled the mapping of ocular circulation at the capillary level. OCTA holds great potential for measuring microvascular changes in response to physiological and pathological alterations.\u003c/p\u003e \u003cp\u003eWith the rapid increase in the myopic population, cataract surgery has also become more common in individuals with high myopia. However, performing cataract surgery in highly myopic individuals poses greater surgical risks and a more complex procedure, often resulting in less favorable postoperative outcomes. When making surgical decisions, both the surgeon and the patient should thoroughly evaluate the benefits and risks of the surgery and determine the most appropriate timing for the procedure. With proper patient selection, phacoemulsification surgery is frequently preferred for cataracts in highly myopic patients due to its good visual acuity outcomes, low complication rates, high predictability, and stability [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to investigate degenerative abnormalities in patients diagnosed with high myopia who underwent cataract surgery using OCTA imaging, to determine and compare the effects on the macula. Through these comparisons, we intend to elucidate how retinal vascular structures are affected following cataract surgery in high myopia patients and to establish a database for future studies.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e This cross-sectional, prospective observational study was reviewed and approved by the Clinical Research Ethics Committee of Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, with number 2640. All patients had provided informed written consent. This trial was conducted in accordance with the tenets of the Declaration of Helsinki. The data that support the findings of this study are available from the corresponding author, on reasonable request.\u003c/p\u003e \u003cp\u003e A total of 79 patients followed in the Ophthalmology Department at Şişli Hamidiye Etfal Training and Research Hospital between 2019 and 2024, who had a high myopia diagnosis with a refractive error of \u0026ge; -6.0 D or an axial length of \u0026ge;\u0026thinsp;26 mm, and met the inclusion criteria, were included in the study. The control group consisted of 71 eyes from 42 patients under clinical follow-up for high myopia alone, while the study group comprised 61 eyes from 37 patients with high myopia who had undergone cataract surgery (phacoemulsification). All patients in the control group were phakic, and all patients in the study group were pseudophakic.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were patients younger than 40 years, who could not maintain fixation required for imaging due to poor visual acuity, with any anterior or posterior segment pathology affecting imaging quality (such as corneal opacity, vitreous opacity, or vitreous hemorrhage), systemic diseases affecting macular function (such as diabetes mellitus, chronic obstructive pulmonary disease, or congestive heart failure), with a history of systemic medication use, additional ocular diseases other than myopia (such as diabetic retinopathy, hypertensive retinopathy, glaucoma, or uveitis), with poor image quality (signal strength index\u0026thinsp;\u0026lt;\u0026thinsp;6/10), with a history of ocular surgery, including cataract surgery, within the last six months, and those who had undergone complicated cataract surgery.\u003c/p\u003e \u003cp\u003eThe gender, age, laterality, and lens status of all included patients were recorded. Refractive measurements were performed using an autorefractometer (Canon RK-F1 Auto Ref-Keratometer, Tokyo, Japan). The spherical equivalent of the refractive error was calculated using the formula: Spherical equivalent\u0026thinsp;=\u0026thinsp;Spherical value + (Cylindrical value/2). The BCVA was determined using the Snellen chart and converted to Logarithm of the Minimum Angle of Resolution (logMAR) equivalents. Axial length measurements were obtained using optical biometry (AL-Scan, Nidek Co, Ltd., Gamagori, Japan).\u003c/p\u003e \u003cp\u003eSpectral-domain OCT imaging (AngioVue, Optovue, Fremont, CA) was performed after pupil dilatation (using tropicamide 0.5% and phenylephrine 2.5% eye drops). All of OCT scans were performed by the same retina specialist (M.E.K), during the same time interval of the day (between 10:00 A.M. and 2:00 P.M.). The foveal center was defined as the location at which the foveal pit is deepest. Central macular thickness (CMT) was measured using the Retina Map mode of OCTA, and subfoveal choroidal thickness (SFCT) was manually measured in the HD (High Definition) Line mode. While CMT was automatically provided by the device, SFCT was manually measured using the caliper tool, defined as the perpendicular distance between the outer boundary of the hyperreflective retinal pigment epithelium (RPE)-Bruch's membrane complex and the outer boundary of the large choroidal vessels extending to the scleral hyperreflectivity. To exclude diurnal variations, all examinations were performed at the same time of day.\u003c/p\u003e \u003cp\u003eMacular imaging with OCTA was performed using a scan of 3 \u0026times; 3 mm centered on the fovea (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). In the central macula, the superficial foveal avascular zone (FAZ) area, as well as the vascular densities (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), were evaluated. The VD of SCP and DCP were analyzed in subregions, including the whole scan area, fovea, parafoveal region, temporal quadrant, superior quadrant, nasal quadrant, and inferior quadrant. The foveal avascular zone (FAZ) is an area on the central fovea that is free from retinal capillaries. The FAZ area (in mm2) was determined from the en face OCTA images. The FAZ diameter was automatically calculated using the nonflow mode in each image of the auto-segmented retina. All of the OCTA images reviewed to ensure the correct segmentation and identify poor-quality scans with motion artifacts or blurred images, or where the data were insufficient for proper analysis. The device included the projection artifact removal algorithm.\u003c/p\u003e \u003cp\u003eThe SCP was automatically measured by the device between 3 microns below the internal limiting membrane (ILM) and 15 microns below the inner plexiform layer. The DCP was automatically measured by the device from 15 microns below the inner plexiform layer to 70 microns beneath. Using the algorithm in the device software, VD (%) in SCP and DCP was measured within areas divided by 1 mm and 3 mm diameter circles centered on the FAZ (foveal and parafoveal regions).\u003c/p\u003e \u003cp\u003eIn descriptive statistics, categorical variables were presented as counts and percentages, while continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (minimum\u0026ndash;maximum values), ratio, and frequency. The normality of continuous variables was assessed using the Kolmogorov-Smirnov or Shapiro-Wilk test. The chi-square test was used to compare categorical variables between groups, and Fisher\u0026rsquo;s exact test was applied when chi-square test assumptions were not met. The Mann-Whitney U test was used for non-normally distributed continuous variables, while the independent samples t-test was used for normally distributed continuous variables. To account for the correlation between eyes from the same patient, statistical analyses were performed using Generalized Estimating Equations (GEE) models. For statistical analysis, SPSS 27.0 (IBM Corp., Armonk, NY, USA) statistical software package was used.\u003c/p\u003e \u003cp\u003eThe correlation between OCTA vascular density measurements and the age and axial length values of high myopia patients was analyzed using Pearson\u0026rsquo;s correlation test for normally distributed data and Spearman\u0026rsquo;s correlation test for non-normally distributed data. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe control group consisted of 14 (33.3%) male and 28 (66.6%) female patients, while the study group included 12 (32.4%) male and 25 (67.6%) female patients. A total of 71 eyes from 42 patients in the control group and 61 eyes from 37 patients in the study group were included in the analysis. The mean age was 64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9 years in the control group and 65.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 years in the study group. The mean duration between cataract surgery and OCTA imaging in the study group was 18.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 months. The age, gender, BCVA, spherical equivalent, axial length and CMT values for both groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of age, gender, best corrected visual acuity (BCVA), spherical equivalent, axial length, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) in both groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, Female/Male, (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA (LogMar), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpherical Equivalent (D), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-8.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAL (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMT (\u0026micro;m), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164.12\u0026thinsp;\u0026plusmn;\u0026thinsp;33.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162.36\u0026thinsp;\u0026plusmn;\u0026thinsp;52.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSFCT (\u0026micro;m), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e147.57\u0026thinsp;\u0026plusmn;\u0026thinsp;53.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137.40\u0026thinsp;\u0026plusmn;\u0026thinsp;36.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAL: Axial length, BCVA: Best corrected visual acuity, CMT: Central macular thickness, SFCT: Subfoveal choroidal thickness\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean FAZ area and VD values in different macular regions for both groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Compared to the control group, the study group showed significantly lower mean VD values across all quadrants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOCTA superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DCP-VD), and foveal avascular zone (FAZ) area values in both groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Group\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhole image SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveal SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e19.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e43,67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e39.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal temporal SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e39.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal superior SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.66\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal nasal SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal inferior SCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.96\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e39.58\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhole image DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveal DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e34.66\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30.03\u0026thinsp;\u0026plusmn;\u0026thinsp;8.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e50.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal temporal DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e52.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal superior DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal nasal DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal inferior DCP-VD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e50.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44.23\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFAZ (mm2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eDCP: Deep capillary plexus, FAZ: Foveal avascular zone, SCP: Superficial capillary plexus, VD: Vessel density\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA positive correlation was found between age and axial length with visual acuity (logMAR), whereas a negative correlation was observed between these parameters and CMT, SFCT and OCTA vascular parameters. The detailed correlation analysis is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation of age and axial length values with best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and OCTA parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAxial Length\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003er value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003er value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCVA (logMAR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.032*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral macular thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubfoveal choroidal thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhole image SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveal SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal temporal SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal superior SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal nasal SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal inferior SCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhole image DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveal DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal temporal DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal superior DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal nasal DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParafoveal inferior DCP-VD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoveal avascular zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBCVA: Best corrected visual acuity, DCP: Deep capillary plexus, SCP: Superficial capillary plexus, VD: Vessel density\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study was conducted to investigate the retinal microvascular status following phacoemulsification surgery in highly myopic patients. To our knowledge, it is the largest prospective study with the longest single-center follow-up period (18.2 months) in the current literature. No other study has evaluated long-term postoperative outcomes in high myopia with a control group consisting of highly myopic patients.\u003c/p\u003e \u003cp\u003eA previous study involving 38 eyes compared OCTA findings before and at 1 day, 1 week, 1 month, and 3\u0026ndash;6 months after phacoemulsification between a high myopia group (axial length\u0026thinsp;\u0026gt;\u0026thinsp;26.5 mm) and a control group (22 mm\u0026thinsp;\u0026lt;\u0026thinsp;axial length\u0026thinsp;\u0026le;\u0026thinsp;24.5 mm). The mean changes in macular vessel density (VD) were significantly higher in high myopic patients on the first postoperative day compared to the control group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study, including 55 eyes, evaluated OCTA findings in high myopia and low myopia groups before and at 1 day, 1 week, 1 month, and 3 months after surgery. Although macular VD values increased in the high myopia group at 1 week and 1 month postoperatively, they were significantly lower at 3 months compared to preoperative levels [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In our study, at an average follow-up of 18.2 months, VD values in the SCP and DCP were lower in all macular quadrants in the high myopia group compared to the control group. Early postoperative increases in VD may be attributed to inflammation; however, our study demonstrates that in the long-term postoperative period, after inflammation has resolved, VD values continue to decrease. Additionally, our control group consisted of highly myopic patients without prior surgery, and our sample size is considerably larger than these studies, further supporting the robustness and reliability of our findings. We believe our results provide a more accurate and reliable assessment of the effects of phacoemulsification surgery in high myopia.\u003c/p\u003e \u003cp\u003eIn a study by Liu et al. involving 58 eyes with normal axial length, perifoveal DCP VD significantly increased at 1 month postoperatively compared to preoperative OCTA findings, but this effect disappeared at 3 months [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, Pilotto et al. reported an increase in intermediate capillary plexus (ICP) and DCP perfusion 1 day after uncomplicated cataract surgery, while SCP perfusion remained unchanged. By 90 days, all parameters had returned to baseline levels, which the authors attributed to the inflammatory nature of the surgery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Our study did not assess early postoperative changes; however, we found a persistent decrease in VD in all quadrants in the high myopia group compared to controls in the long term. It is possible that highly myopic eyes are more vulnerable to surgical stimulation, which may lead to permanent retinal microvascular alterations through mechanisms such as local inflammation, ultrasound energy, perfusion fluid toxicity, or light exposure.\u003c/p\u003e \u003cp\u003eA study comparing diabetic and non-diabetic patients undergoing cataract surgery found that SCP VD was significantly higher in the diabetic group at 3 months postoperatively [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This suggests that diabetic eyes, like highly myopic eyes, may experience prolonged or even permanent vascular changes due to surgical trauma and inflammation. Since diabetes is an inflammatory disease, surgery-induced inflammation may result in a persistent VD increase. In contrast, high myopia is a condition prone to atrophy; thus, a long-term VD reduction following surgery is inevitable. Although our study findings differ, the distinct pathophysiologies of these conditions support the hypothesis that long-term changes in VD may be permanent.\u003c/p\u003e \u003cp\u003ePrevious studies comparing FAZ areas between high myopia and normal axial length groups found no significant differences [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, another study found no significant difference in FAZ area in diabetic and non-diabetic patients within the first 3 months after uncomplicated cataract surgery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, OCTA imaging before and 2 weeks after cardiopulmonary bypass surgery revealed no significant change in FAZ area [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Consistent with the literature, our study also found no significant difference in FAZ area between the two groups. The lack of difference in FAZ area across studies with varying axial lengths and systemic conditions reinforces our finding that FAZ remains unaffected within a homogeneous disease group.\u003c/p\u003e \u003cp\u003eA study investigating long-term (12-month) changes in SFCT after cataract surgery found no significant difference compared to preoperative values [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The same study suggested that uncomplicated phacoemulsification might cause subclinical changes in CMT, likely due to surgical inflammation, but that CMT eventually returned to baseline. Similarly, our study found no significant long-term differences in CMT and SFCT between highly myopic eyes with and without cataract surgery.\u003c/p\u003e \u003cp\u003eFan et al. evaluated participants under 40 years old with different refractive statuses and found a negative correlation between axial length and macular VD using OCTA [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Our study also demonstrated a negative correlation between axial length and OCTA parameters, supporting these findings.\u003c/p\u003e \u003cp\u003eThe limitations of this study include the absence of early postoperative data before and after phacoemulsification. However, we addressed this limitation with a prospective study design, a large sample size, and a control group consisting of highly myopic patients. Additionally, the use of a single center, a single device for data collection, and automated device-generated measurements enhance the reliability of our results.\u003c/p\u003e \u003cp\u003eIn conclusion, we demonstrated that, in highly myopic patients, long-term microvascular structures and flow parameters in the macular region are affected after cataract surgery, while the FAZ area remains unchanged. The decreased VD values in the macula in the long-term postoperative period may be a potential prognostic indicator in highly myopic cataract patients; however, the clinical significance of these findings remains unclear. Further longitudinal studies with larger patient cohorts and more frequent follow-up intervals are warranted to elucidate whether these changes translate into meaningful functional outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest. All authors have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Clinical Research Ethics Committee of Şişli Hamidiye Etfal Training and Research Hospital. (2020/No 2640).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eAll authors contributed to the study conception and design.Material preparation, data collection and analysis were performed by [Mehmet Egemen Karataş], [Dilek G\u0026uuml;ven], [Mehmet Demir], [Semra Tiryaki Demir] The first draft of the manuscript was written by [Mehmet Egemen Karataş] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFlaxman, S. R., Bourne, R. R., Resnikoff, S., Ackland, P., Braithwaite, T., Cicinelli, M. V., ... \u0026amp; Zheng, Y. (2017). Global causes of blindness and distance vision impairment 1990\u0026ndash;2020: a systematic review and meta-analysis. The Lancet Global Health, 5(12), e1221-e1234.\u003c/li\u003e\n \u003cli\u003eBanashefski B, Rhee MK, Lema GMC. High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2023;12(8):3045. Published 2023 Apr 21. doi:10.3390/jcm12083045.\u003c/li\u003e\n \u003cli\u003eHolden, B.A.; Fricke, T.R.; Wilson, D.A.; Jong, M.; Naidoo, K.S.; Sankaridurg, P.; Wong, T.Y.; Naduvilath, T.J.; Resnikoff, S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016, 123, 1036\u0026ndash;1042.\u003c/li\u003e\n \u003cli\u003eRhee, M.K. Update on Myopia Control: The US Perspective. Eye Contact Lens 2022, 48, 105\u0026ndash;109.\u003c/li\u003e\n \u003cli\u003eZhao, X., Ding, X., Lyu, C., Li, S., Liu, B., Li, T., ... \u0026amp; Lu, L. (2020). Morphological characteristics and visual acuity of highly myopic eyes with different severities of myopic maculopathy. \u003cem\u003eRetina\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(3), 461-467.\u003c/li\u003e\n \u003cli\u003eKoustenis A Jr, Harris A, Gross J, Januleviciene I, Shah A, Siesky B. Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research. \u003cem\u003eBr J Ophthalmol\u003c/em\u003e. 2017;101(1):16-20. doi:10.1136/bjophthalmol-2016-309389.\u003c/li\u003e\n \u003cli\u003eBao, Y. Z., \u0026amp; Cao, X. G. (2023).\u0026nbsp;[Zhonghua yan ke za zhi] Considering about the timing of cataract surgery with high myopia Chinese journal of ophthalmology,\u0026nbsp;59(12), 967\u0026ndash;969. doi:10.3760/cma.j.cn112142-20230923-00110.\u003c/li\u003e\n \u003cli\u003eYang Y, Zeng Z, Mu J, Fan W. Macular vascular density and visual function after phacoemulsification in cataract patients with non-pathological high myopia: a prospective observational cohort study. \u003cem\u003eGraefes Arch Clin Exp Ophthalmol\u003c/em\u003e. 2022;260(8):2597-2604. doi:10.1007/s00417-022-05606-9.\u003c/li\u003e\n \u003cli\u003eLi, T., Guadie, A., Feng, L., Fan, J., Jiang, Z., \u0026amp; Liu, F. (2020). Influence of cataract surgery on macular vascular density in patients with myopia using optical coherence tomography angiography. \u003cem\u003eExperimental and therapeutic medicine\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(6), 1-1.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Liu, J., Liu, Q., Yu, H., Xia, Y., Zhang, H., Geng, C., \u0026amp; Dong, L. (2021). Microvascular changes in macular area after phacoemulsification and its influencing factors assessed by optical coherence tomography angiography. \u003cem\u003eTherapeutics and clinical risk management\u003c/em\u003e, 405-414.\u003c/li\u003e\n \u003cli\u003ePilotto, E., Leonardi, F., Stefanon, G., Longhin, E., Torresin, T., Deganello, D., ... \u0026amp; Midena, E. (2019). Early retinal and choroidal OCT and OCT angiography signs of inflammation after uncomplicated cataract surgery. \u003cem\u003eBritish Journal of Ophthalmology\u003c/em\u003e, \u003cem\u003e103\u003c/em\u003e(7), 1001-1007.\u003c/li\u003e\n \u003cli\u003eFeng L, Azhati G, Li T, Liu F. Macular Vascular Density Changes following Cataract Surgery in Diabetic Patients: An Optical Coherence Tomography Angiography Study. \u003cem\u003eJ Ophthalmol\u003c/em\u003e. 2021;2021:6641944. Published 2021 Mar 26. doi:10.1155/2021/6641944.\u003c/li\u003e\n \u003cli\u003eUcak, T., Icel, E., Yilmaz, H., Karakurt, Y., Tasli, G., Ugurlu, A., \u0026amp; Bozkurt, E. (2020). Alterations in optical coherence tomography angiography findings in patients with high myopia. \u003cem\u003eEye\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(6), 1129-1135.\u003c/li\u003e\n \u003cli\u003eŞimdivar GHN, İncekalan TK, G\u0026uuml;nd\u0026uuml;z A. Evaluation of retinal and peripapillary vessel density and subfoveal choroidal thickness changes in patients undergoing cardiopulmonary bypass: An OCTA study. \u003cem\u003eIndian J Ophthalmol\u003c/em\u003e. 2024;72(Suppl 1):S119-S124. doi:10.4103/IJO.IJO_2800_22.\u003c/li\u003e\n \u003cli\u003eYılmaz T, Karci AA, Yilmaz İ, Yılmaz A, Yıldırım Y, Sakalar YB. Long-Term Changes in Subfoveal Choroidal Thickness After Cataract Surgery. \u003cem\u003eMed Sci Monit\u003c/em\u003e. 2016;22:1566-1570. Published 2016 May 9. doi:10.12659/msm.898714.\u003c/li\u003e\n \u003cli\u003eFan H, Chen HY, Ma HJ, Chang Z, Yin HQ, Ng DS, Cheung CY, Hu S, Xiang X, Tang SB, Li SN. Reduced macular vascular density in myopic eyes. \u003cem\u003eChin Med J (Engl)\u0026nbsp;\u003c/em\u003e2017;130:445\u0026ndash;451. doi: 10.4103/0366-6999.199844.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cataract, high myopia, macula, optical coherence tomography angiography","lastPublishedDoi":"10.21203/rs.3.rs-8277380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8277380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo investigate long-term structural changes in the retina of highly myopic patients following uncomplicated cataract surgery using optical coherence tomography angiography (OCTA).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional, observational study included 61 eyes of 37 highly myopic patients who underwent uncomplicated cataract surgery as the study group and 71 eyes of 42 highly myopic patients under clinical follow-up as the control group. Retinal vascular structures in the macular regions were examined in detail and quantitatively assessed using OCT and OCTA. Data from these two groups were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were no statistically significant differences between the groups in terms of age, sex, best corrected visual acuity, or axial length. The mean duration between cataract surgery and OCTA imaging in the study group was 18.2 months. A statistically significant decrease in microvascular vessel density was observed in all quadrants of the foveal and parafoveal areas in the study group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no significant difference was found in the foveal avascular zone area between the groups (p\u0026thinsp;=\u0026thinsp;0.267).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn highly myopic patients undergoing uncomplicated cataract surgery, long-term macular vessel density was reduced compared to the control group. Our study is significant as it is the first to assess retinal vascular structural changes in cataract-operated highly myopic patients with a control group consisting of highly myopic individuals. Furthermore, this study provides a valuable perspective for cases where postoperative visual decline cannot be explained despite the absence of complications.\u003c/p\u003e","manuscriptTitle":"Retinal Vascular Changes in Optical Coherence Tomography Angiography of Highly Myopic Patients Undergoing Uncomplicated Cataract Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 08:18:44","doi":"10.21203/rs.3.rs-8277380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"caf4589b-6897-4c9e-a624-39dadad058d7","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-21T11:53:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 08:18:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8277380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8277380","identity":"rs-8277380","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}