Evaluation of vascular density of macula and optic DİSC HEAD before and after cataract surgery in patients with pseudoexfoliation syndrome

Objective: In this study, we aimed to evaluate the vascular flow of the macula and optic nerve head with optical coherence tomography angiography (OCT-A) before and after uncomplicated cataract surgery in patients with pseudoexfoliation syndrome (PES) and age-related cataracts. Method: Sixty-two eyes of 62 patients who applied to Istanbul University Istanbul Medical Faculty Department of Ophthalmology and whose surgeries were completed without complications were included in the study. Two patients were excluded from the study due to the cystoid macular edema 1 month after the operation. The remaining patients were divided into two groups. While 30 patients with PES constituted the first group (group with PES), 30 patients with age-related cataract constituted the second group (Control group). Patients underwent a complete ophthalmologic examination including best corrected visual acuity (BCVA), slit-lamp examination, measurement of intraocular pressure (IOP), and fundus examination. Flaremeter, corneal endothelial cell count (CEC), axial length (AL) parameters were measured and recorded. OCT-A with macular and optic nerve head superficial vascular plexus density (SVPD)(%), deep vascular plexus density (DVPD)(%), choriocapillary vascular density (CVD)(%), and ganglion cell complex (GCC) parameters were evaluated before and after the surgery. All of the parameters were compared between both groups and within the group separately. Results: Best corrected visual acuity was significantly lower in the PES group than in the control group both before the operation (p=0.045), and after the operation (p=0.036). Although the IOP measurement before the operation was significantly higher in the PES group than the control group (p=0.006), there was no significant difference between the two groups after the operation (p>0.05). Flaremeter measurements in the PES group was significantly higher (p<0.001) compared to the control group before the surgery, and it was also found to be higher after the operation (p=0.001). Corneal endothelial cell count measurements was found to be significantly lower in the PES group than in the control group (p=0.014) before surgery. When the macular and optic disc head SVPD, DVPD, CVD and GCC parameters measured by OCT-A were evaluated, no significant difference was found between the two groups when compared before and after the surgery (p>0.05). When the PES and control groups were evaluated within themselves, there was a significant increase in all parameters of the macula and optic nerve head SVPD, DVPD, CVD and GCC after the operation compared to the preoperative period (p<0.05). Conclusion: After uncomplicated cataract surgery, an increase in foveal, parafoveal and optic nerve head vascular vessel density was found in both PES and age-related cataract patients. A decrease was detected in IOP measurements. When the two groups were compared, there was no difference after the operation in the vascular density of the foveal, parafoveal and optic nerve head compared to the preoperatively, while the preoperative IOP and flaremetry were higher in the PES group, and the CEC was found to be lower. Although vision improvement and IOP control are achieved after cataract surgery, it is seen that there is an increase in vascular flow in the macula and optic nerve head. Key Words: Macular Vascular Vessel Density, Optic Disc Head Vascular Plexus Dansity, Cataract Surgery, Optical Coherence Tomography Angiography