The Role of Macular Optical Coherence Tomography in Patients Undergoing Cataract Surgery With Clinically Normal Fundus

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Abstract Purpose: The purpose of this study is to assess the clinical relevance of incorporating a spectral-domain optical coherence tomography (OCT) examination into the routine preoperative evaluation of patients scheduled for a standard cataract surgical procedure and to document the subtle macular pathologies that are missed in preoperative clinical examination. Setting and Design: A prospective observational study at the Department of Ophthalmology, Vision Eye Centre, New Delhi, Delhi, India. All patients were examined by one retina specialist and operated by an experienced cataract surgeon. Patients and Methods: A total of 300 patients were recruited and divided into two groups of 150 participants each. Patients in Group 1 underwent preoperative OCT macula, whereas patients in Group 2 underwent a thorough clinical fundus evaluation but not OCT. Postoperatively, OCT was done in patients with suboptimal visual acuity to assess the reason. Suboptimal visual acuity is defined as best corrected visual acuity of 20/30 or worse in an eye with previously undiagnosed macular pathology. Any changes in the management plan or additional vitreoretinal intervention planned after the detection of macular pathology on OCT were noted. Results and Conclusions: Among 150 patients in Group 1, 12 had drusen, 4 had epiretinal membrane, and 1 had paratoveal pigment epithelial detachment. All (100%) patients had 6/6 visual acuity on postoperative day 14. In Group 2, 149 patients (99.33%) had 6/6 visual acuity by postoperative day 14, and 1 (0.67%) had 6/9 visual acuity. Postoperatively, no patient had suboptimal visual acuity and all patients with normal fundus on examination achieved good visual outcomes. Preoperative OCT did not significantly alter the surgical plan or influence postoperative visual prognosis, although we were able to detect subtle pathologies such as drusen and epiretinal membrane, which were not clinically apparent in a few patients.

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