Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Laboratory for Ophthalmic Image Analysis, Medical University of Vienna, Vienna, Austria.
Acta Ophthalmol. 2024 Aug;102(5):e862-e868. doi: 10.1111/aos.16667. Epub 2024 Mar 5.
To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation.
This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm.
Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery.
Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified.
使用基于人工智能的自动视网膜分层分割技术，评估在代表性年龄相关性白内障人群中，飞秒激光辅助白内障手术（LCS）和手动白内障手术（MCS）后 18 个月视网膜各层的变化。
这是一项在奥地利维也纳医科大学进行的前瞻性、随机和个体内对照研究，纳入了 60 名患者。双侧同日行 LCS 和 MCS，采用随机序列。为了深入了解囊样黄斑水肿（CME）的发展情况，在术前和术后 18 个月内，对中央 1mm、3mm 和 6mm 处的视网膜层厚度进行了测量。
56 名患者完成了所有随访。与 MCS 相比，LCS 在任何随访时间点都不会影响任何研究的视网膜层（p＞0.05）。在中央 1mm 处，术后 1 周总视网膜厚度（TRT）显著增加，随后维持在较高水平。在 3mm 和 6mm 处，TRT 仅在术后 3 周和 6 周后增加，然后在 18 个月时再次下降。与术前厚度相比，TRT 仍显著增加（p＜0.001）。视力不受黄斑增厚的影响，也未观察到 CME 病例。内核层（INL）和外核层（ONL）是导致总 TRT 增加的主要原因。术后 1 周光感受器（PR）下降，但术后 18 个月恢复术前水平。
与手动高流体性超声乳化相比，低能量飞秒激光预处理不会影响任何部位视网膜层的厚度。术后 18 个月，TRT 未恢复到术前水平。成功确定了亚临床 CME 发展的致病层。
