Evaluation of choroidal and retinal structures following un complicated phacoemulsification in patients with pseudoex foliation cataract

ABSTRACT Evaluation of Choroidal and Retinal Structures Following Uncomplicated Phacoemulsification in Patients with Pseudoexfoliation Cataract Research Assistant İbrahim Halil TÜRKMAN, MD Department of Ophthalmology Supervisor: Assistant ProfessorBurak ÖREN, MD Pseudoexfoliationsyndrome (PEX) is a microfibrillopathythatincreasesthe risk of intraoperative complications and is associated with glaucomatous progression, while the retinal and choroidal responses to surgery remainin sufficiently clarified. This study aimed to investigate early structural changes in macular layers, the retinal nerve fiber layer (RNFL), and choroida lthickness in PEX eyes undergoing uncomplicated phacoemulsification using advanced imaging modalities. This prospective, single-center study included 38 PEX patients whounderwentphacoemulsification (21 men, 17 women; meanage 70.7 ± 6.2 years). Bestcorrected visualacuity (BCVA; logMAR), intraocular pressure (IOP; Goldmannapplanation), and structural parameters were evaluated preoperatively and at postoperative month 1. Macular layert hicknesses, central maculart hickness (CMT), retinal pigment epithelium (RPE), and macular/peripapillary RNFL were measured with spectral-domain OCT (SDOCT); subfoveal, temporal, and nasal choroidal thicknesses were obtained with enhanceddepth imaging OCT (EDI-OCT). Following phacoemulsification, BCVA improved from 1.00 (0.50–1.80) to 0.20 (0.00– 0.80) logMAR (p < 0.001), and IOP decreased from 19.50 to 14.00 mmHg (p < 0.001). Widespread macular thickening was observed; significant increases occurred in the inner plexiform layer (p = 0.035), RPE (p = 0.005), and CMT (p = 0.041), while the ganglion cell layer remained stable (p = 0.350). Both macular and peripapillary RNFL increased significantly (p < 0.001and p = 0.003, respectively). Segmental analys is revealed pronounced XII thickening in temporal sectors (p = 0.006–0.038) and in the superonasalregion (p = 0.001), whereas changes in the nasal and inferonasalsectors were not significant. Although choroidal thickness tendedto increas eacrossalllocations, differences did not reach statistical significance (all p > 0.05). Inconclusion, uncomplicated phacoemulsification in PEX yields early improvement in visual function and IOP reduction, accompanied by layer- and segment-specific adaptive thickening in macular structures and the RNFL, while choroidal thickness is preserved. The sefindings support the clinical value of multimodal OCT, particularly focused assessment of temporal and superonasal segments, in the postoperative follow-up of PEX patients. Keywords:Pseudoexfoliationsyndrome, phacoemulsification, spectral-domain OCT, enhanceddepthimaging OCT, retinal nerve fiber layer, centralmacularthickness, choroidy