Incorporating OCT in Cataract Preoperative Armamentarium: Additional Need or Additional Costs
Subtle macular pathologies, difficult to diagnose in presence of a cataract are often a cause of postoperative dissatisfaction for the patient and embarrassment for the surgeon. Purpose of this study is to determine the usefulness of preoperative OCT examination to detect asymptomatic macular abnormalities in patients scheduled to undergo cataract surgery.
Prospective observational series included one eye of patients undergoing cataract surgery for senile cataracts(Grades 1 -4, with or without posterior subcapsular cataract). None of the patients had past history of poor vision or previous retinal/ocular disorder. Preoperatively no retinal/macular pathology was identified on fundus evaluation. All eyes were subject to a Macular High-Definition 5-Line Raster OCT evaluation using Spectral Domain OCT(Zeiss). Posterior vitreous attachment, macular structure and any abnormalities/variations therein were noted. Quantitative measurement of central macular thickness (CMT) made. Presence of macular structural abnormalities was the primary outcomes measure.
Ongoing study: Preliminary data of 122 eyes included. OCT examination could not be captured in 2 eyes (1.6%).Mean CMT was 195+23microns. There was a clinical suspicion of epimacular membrane in 4 eyes (3.3%) and drusen in 2 eyes (1.6%), however OCT examination ruled out any pathology. In the presence of a normal fundus evaluation, OCT examination revealed presence of Epiretinal membrane (ERM) in 14 eyes(11.6%), Foveal attenuation in 4 eyes(3.3%), Vitreomacular traction in 4 eyes (3.3%). Based on abnormal OCT findings, we avoided implanting multifocal IOLs in 2 eyes. Results will be updated at time of presentation.
A significant proportion of patients have asymptomatic macular anomalies detected only on OCT. These act as prognostic factors for postoperative visual prognosis. More importantly it helps the surgeon decide the IOL strategy, particulary for premium IOL implantation. So we believe that OCT examination has an important place in the preoperative armamentarium.