Title : Optical Coherence Tomography Angiography of Retinal Microvasculature in Diabetic Eyes Without Retinopathy Undergoing Cataract Surgery: A Prospective Observational Study
Abstract:
Background:
In diabetic patients without retinopathy, unexplained suboptimal visual recovery following cataract surgery remains a clinical challenge. While retinal microvascular alterations may exist prior to visible diabetic retinopathy (DR), their subclinical detection and prognostic significance remain underexplored. Optical Coherence Tomography Angiography (OCTA) has the potential to uncover early, preclinical ischemic changes, but its role in surgical planning and visual outcome prediction is not yet established.
Objective:
To identify and quantify subclinical retinal microvascular changes in diabetic eyes without DR using OCTA before and after cataract surgery, and to assess their predictive value for postoperative visual recovery.
Methods:
This prospective study enrolled 94 diabetic patients (without clinical DR) undergoing cataract surgery. OCTA (3×3 mm macular scans) was performed preoperatively and at postoperative day 30. Parameters assessed included vessel density (VD) in superficial and deep capillary plexuses, foveal avascular zone (FAZ) area, and best-corrected visual acuity (BCVA). Changes in OCTA metrics and their correlation with visual outcomes were statistically analyzed.
Results:
Preoperatively, subtle reductions in vessel density and FAZ abnormalities were observed in a significant subset of eyes despite normal fundus and OCT findings. Postoperatively, these subclinical ischemic signatures persisted in certain cases and were strongly associated with suboptimal visual improvement (p?<?0.05). In contrast, eyes with preserved preoperative OCTA profiles demonstrated superior visual outcomes. Notably, these findings suggest that early retinal microvascular compromise — undetectable by routine imaging — may underlie postoperative visual disparity.
