Prevalence of Occult Macular Pathologies Detected by Optical Coherence Tomography in Patients Scheduled for Cataract Surgery

OBJECTIVES: To investigate the prevalence of macular pathologies detectable only by optical coherence tomography (OCT) and not suspected on fundoscopic examination before cataract surgery in a large series of Turkish patients and to determine associated risk factors.
METHODS: Medical records of patients who underwent cataract surgery, had normal fundoscopic findings during preoperative evaluation, and underwent macular OCT were retrospectively reviewed for demographic data, ophthalmological findings, and systemic examination results. Patients were divided into normal and abnormal OCT groups according to their macular OCT results. Patients in the abnormal OCT group were further analyzed for the prevalence of OCT-detected occult macular pathologies and associated risk factors.
RESULTS: Data from 1.091 eyes were included in the study. Macular pathology was detected on OCT in 9.2% of patients. Among these patients, 40 (40%) had age-related macular degeneration, 31 (31%) had epiretinal membrane, 11 (11%) had vitreomacular traction, 8 (8%) had lamellar macular hole, 5 (5%) had diabetic macular edema, and 5 (5%) had macular pseudohole. The mean age of patients with occult macular pathology was significantly higher than that of patients with normal OCT findings (p=0.001). 78.0% of patients with retinal pathology were 70 years of age or older. Advanced age was identified as the most important predictor of occult macular pathology (OR: 1.086, p=0.001).
DISCUSSION AND CONCLUSION: Reliance solely on fundoscopic examination would result in approximately 1 in 10 eyes with occult macular pathology being overlooked. OCT screening should be considered prior to cataract surgery, particularly in elderly patients.

Keywords: Cataract, preoperative assessment, optical coherence tomography, occult macular pathology