Delhi Journal of Ophthalmology

Postsurgical Retinal Nerve Fiber Layer and Macular Thickness Analysis by Optical Coherence Tomography in Hypermature Cataract of Presenile Patients

Mir Alam Siddique1, Arup Jyoti Dev Sarma2, Kamal Hasan1, Nasima Sultana3, Sultana Jesmin Ahmed4
1Regional Institute of Ophthalmology, Gauhati Medical College, Guwahati, Assam, India; 2Assam Down Town University, Panikhaiti, Guwahati, Assam, India; 3Department of Physiology, Gauhati Medical College, Guwahati, Assam, India; 4Department of Community Medicine, Assam Medical College, Dibrugarh; India.

Editor-in-Chief, Delhi Journal of Ophthalmology, Dr R.P.Centre, AIIMS.

Corresponding Author:

Nasima Sultana
Department of Physiology, 
Gauhati Medical College, Guwahati, Assam, India
Email id:

Published Online: 31-JAN-2019

Purpose: To study the changes in retinal nerve fiber layer (RNFL) and fast macular thickness (FMT) after cataract surgery in presenile patients with hypermature cataract.
Methods: It was a clinical randomized study in 157 eyes of 157 patients who underwent uneventful cataract surgery with intraocular lens (IOL) implantation performed by a single surgeon. All patients were aged between 40-55 years. One group underwent phacoemulsification (PHACO) procedure and the other group underwent small incision cataract surgery (SICS) procedure. The operated eyes were examined on the preoperative day, 1st postoperative day, 2nd week, 6th week, 12th week and 24th week after surgery using FMT and RNFL protocol of optical coherence tomography (OCT). Patients having any other eye diseases were excluded from the study. 
Results: Macular thickness after PHACO and SICS were found to be highest at 6th post operative week, with a mean average value of 227.45±26.46µm and 206.71±25.36µm in SICS and PHACO group respectively. Small incision cataract surgery group had significantly higher thickness than the phacoemulsification group (p=0.001). Difference of RNFL thickness between PHACO and SICS was found to be highest during 6th week follow up (p=0.001), with a mean average value of 94.65±16.82µm and 92.21±16.66µm respectively. 
Conclusion: This novel study reveals that surgery on hypermature cataract of presenile patients affects the RNFL and macular thickness. These changes are highest during the 6th postoperative week, resolving gradually towards the 24th postoperative week. There is a significant difference in postoperative increase in macular and RNFL thickness between SICS and phacoemulsification surgery procedures, both being significantly higher in the SICS group than the phacoemulsification group, the highest difference being at 6th postoperative week. It indicates PHACO to be a preferable surgery in presenile hypermature cataract with regard to postoperative increase in macular and RNFL thickness.

Keywords :Macular thickness, RNFL, OCT, Cataract surgery, Presenile hypermature cataract