Effect of phacoemulsification surgery on choroidal and retinal microvasculature in hypertensive patients: an optical coherence tomography angiography study

Background Cataract surgery induces structural and vascular changes in the retina and choroid, which can be quantified by optical coherence tomography angiography (OCTA). Systemic hypertension may influence these microvascular responses, potentially affecting postoperative recovery. This study compared postoperative OCTA parameters between hypertensive and normotensive eyes following uncomplicated phacoemulsification Aim of the work To evaluate changes in choroidal and retinal microvasculature in hypertensive patients after phacoemulsification, compared to normal participants, using Optical Coherence Tomography Angiography (OCTA). Patients and methods This prospective comparative case-control observational study included 100 eyes of 65 patients, divided into two groups: hypertensive patients with or without hypertensive retinopathy (50 eyes) and non-hypertensive control group (50 eyes). Preoperative and postoperative parameters were assessed using OCT and OCTA. Results Preoperatively, whole and perifoveal SVD, and foveal choriocapillaris were significantly lower in the hypertensive group. Postoperatively, parafoveal SVD was significantly higher in hypertensive patients at 3 months. The hypertensive group had lower choriocapillaris vessel density and inside-disc vessel density at 1 week postoperatively. No correlation was found between OCTA parameter changes and duration or grading of hypertension. Conclusion OCTA revealed significant microvascular changes in hypertensive patients, including lower SVD and choriocapillaris densities preoperatively. While phacoemulsification provides comparable visual and IOP benefits in both groups, hypertensive eyes demonstrated attenuated postoperative increases in retinal, choriocapillaris and inside disc vessel density compared with normotensive eyes, suggesting a reduced microvascular recovery following cataract surgery. OCTA may be a valuable tool for detecting these subtle differences, potentially guiding postoperative monitoring in hypertensive patients.