Pre-operative optical coherence tomography macula: An indispensable investigation to predict post-operative outcomes

Abstract

Objectives: The aim of the study was to identify clinically undiagnosed macular pathologies and determine their distribution in pre-operative cataract patients. Materials and Methods: The present study is a hospital-based cross-sectional study of patients who attended the ophthalmology OPD to undergo pre-operative evaluation for cataract surgery in a tertiary care government hospital in South Gujarat, India, during a period from July 2019 to September 2020. The inclusion criteria for the study were patients above the age of 40 years with immature cataracts that allowed for optical coherence tomography (OCT) scan acquisition. Patients with prior history of macular disease or those who have undergone treatment for retinal pathologies were excluded from the study. Two hundred cataract patients who met the defined inclusion criteria and gave an informed written consent were enrolled. Three hundred and ten eyes with a normal fundoscopic appearance underwent spectral domain OCT macula examination before cataract surgery. The OCT macula scans were scrutinised for any undiagnosed subtle macular pathologies and were documented. Cataract surgery with explained visual prognosis was undertaken in specific cases correlating with their macular findings and surgery was deferred in a few. Results: Among 200 study participants, 310 eyes had unremarkable fundoscopic appearance on ophthalmoscopy. While undergoing OCT examination, 65 (20.96%) eyes out of 310 showed abnormalities. The most common presentation was epiretinal membrane in 22 eyes (7.09%) followed by pigment epithelial detachment in 14 (4.5%) eyes. Other findings were drusen (nine eyes), lamellar macular hole (five), vitreomacular traction (five), IS-OS junction abnormalities (four), retinal pigment epithelium alterations (two), juxtafoveal telangiectasia (one), foveal thinning (one), pseudovitelliform lesion (one) and spongy oedema (one). Conclusion: Routine fundoscopic examination for pre-operative cataract evaluation of the 200 study participants failed to identify subtle macular pathologies which were further diagnosed on SD-OCT Macula. Sixty-five eyes (20.96%) out of the 310 eyes were found to have macular pathologies. The various findings that were obtained provided us an insight into the appropriate choice of intraocular lenses, required surgical consents and the therapeutic strategy for each individual patient. Thus, we can conclude that OCT macula is an indispensable investigation before cataract extraction to avoid unsolicited post-operative surprises and medicolegal conundrums.