# Automated Longitudinal Quantification of Retinal and Choroidal Vascular Changes After Phacoemulsification

## TL;DR

This study uses advanced imaging to track how retinal and choroidal blood vessels change after cataract surgery, finding increases in retinal vessel density and subtle changes in choroidal vessels.

## Contribution

The study introduces an automated method for longitudinal OCTA analysis to quantify vascular changes after cataract surgery.

## Key findings

- Retinal vessel density and structural complexity increased significantly over two months post-surgery.
- Choroidal vessel diameter decreased over time, while density remained stable.
- Clinical factors like anesthesia method and sex influenced specific choroidal vascular changes.

## Abstract

We investigated how small blood vessels in the retina and choroid change after uncomplicated cataract surgery using advanced imaging. Retinal vessel density and structural complexity increased over two months, while deeper choroidal vessel caliber showed subtle changes. The results suggest that cataract surgery may be associated with microvascular alterations after accounting for image quality, providing insight into postoperative vascular dynamics and informing future research on ocular vascular health.

Background/Objectives: To comprehensively evaluate longitudinal retinal and choroidal vascular changes after phacoemulsification using automated optical coherence tomography angiography (OCTA) analysis and to investigate clinical factors influencing these changes. Methods: This retrospective study included 26 subjects (31 eyes) who underwent uncomplicated phacoemulsification. OCTA was performed at baseline and at 1 day, 1 week, 1 month, and 2 months postoperatively. Automated quantitative analysis was applied to assess vessel density- and structure-related parameters in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and Haller layer. Longitudinal changes were analyzed using repeated-measures analysis of variance, with time × clinical factor interactions evaluated for diabetes mellitus, anesthesia method, and sex. Inter-layer associations were assessed using Spearman correlation analysis. Results: Significant longitudinal changes were observed in retinal layers. In the SCP, vessel density increased from 42.59 ± 1.46 at baseline to 44.10 ± 1.44 at 2 months (p = 0.002), accompanied by increases in vessel length and node counts (all p < 0.001). In the DCP, vessel density increased from 34.66 ± 5.98 to 38.65 ± 4.83 (p < 0.001). In contrast, choriocapillaris-related parameters showed no significant overall time effect. In the Haller layer, mean vessel diameter decreased significantly over time (p < 0.001), while density-related metrics remained unchanged. ΔVAD demonstrated positive correlations between adjacent layers (SCP–DCP and DCP–choriocapillaris) and a negative correlation between choriocapillaris and Haller layers. Diabetes mellitus showed no significant longitudinal effect, whereas retrobulbar anesthesia and sex significantly modified selected choroidal trajectories. Conclusions: Automated and integrated OCTA analysis revealed layer-dependent retinal and choroidal vascular responses after phacoemulsification, with coordinated changes confined mainly to anatomically adjacent layers and selective modulation by clinical factors.