Active-fluidics versus gravity-fluidics in uncomplicated cataract surgery: using optical coherence tomography...

To compare, using optical coherence tomography angiography (OCTA), the earliest changes and damages to macular and optic disc microcirculation after active-fluidics system (AFS) and gravity-fluidics system (GFS) procedures in uncomplicated cataract surgery.

We included 42 eyes affected by uncomplicated cataracts and divided them into two groups: 21 eyes were randomly assigned to an AFS group and 21 eyes were randomly assigned to a GFS group. Expert examiners performed OCTA 30 ± 10 min before surgery (T0), 30 ± 8 min after surgery (T1), 24 ± 2 h after surgery (T2) and 7 days after surgery (T3).

No significant differences at T1 were detected between the groups. At T2, eyes in the GFS group exhibited a whole macula deep capillary plexus vessel density of 37.9 ± 5.8%, which was significantly lower than that of the eyes in the AFS group (42.2 ± 5.7%; p = 0.048). At T3, eyes in the GFS group exhibited a significantly higher retinal nerve fibre layer thickness in the nasal (p = 0.020) and inferior (p = 0.045) quadrant, and a significantly lower peripapillary vessel density in the inferior quadrant of the papilla (p = 0.036) compared with eyes in the AFS group.

The AFS procedure appears to protect macular and optic disc microcirculation during phacoemulsification, and it may represent a more prudent approach, particularly in cases that require specific care to preserve residual peripapillary and macular vasculature (e.g., diabetic or glaucomatous eyes).