Automated Longitudinal Quantification of Retinal and Choroidal Vascular Changes After Phacoemulsification.

BACKGROUND/

OBJECTIVES

To comprehensively evaluate longitudinal retinal and choroidal vascular changes after phacoemulsification using automated optical coherence tomography angiography (OCTA) analysis and to investigate clinical factors influencing these changes.

METHODS

This retrospective study included 26 subjects (31 eyes) who underwent uncomplicated phacoemulsification. OCTA was performed at baseline and at 1 day, 1 week, 1 month, and 2 months postoperatively. Automated quantitative analysis was applied to assess vessel density- and structure-related parameters in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and Haller layer. Longitudinal changes were analyzed using repeated-measures analysis of variance, with time × clinical factor interactions evaluated for diabetes mellitus, anesthesia method, and sex. Inter-layer associations were assessed using Spearman correlation analysis.

RESULTS

Significant longitudinal changes were observed in retinal layers. In the SCP, vessel density increased from 42.59 ± 1.46 at baseline to 44.10 ± 1.44 at 2 months (p = 0.002), accompanied by increases in vessel length and node counts (all p < 0.001). In the DCP, vessel density increased from 34.66 ± 5.98 to 38.65 ± 4.83 (p < 0.001). In contrast, choriocapillaris-related parameters showed no significant overall time effect. In the Haller layer, mean vessel diameter decreased significantly over time (p < 0.001), while density-related metrics remained unchanged. ΔVAD demonstrated positive correlations between adjacent layers (SCP-DCP and DCP-choriocapillaris) and a negative correlation between choriocapillaris and Haller layers. Diabetes mellitus showed no significant longitudinal effect, whereas retrobulbar anesthesia and sex significantly modified selected choroidal trajectories.

CONCLUSIONS

Automated and integrated OCTA analysis revealed layer-dependent retinal and choroidal vascular responses after phacoemulsification, with coordinated changes confined mainly to anatomically adjacent layers and selective modulation by clinical factors.