Abstract:  Objective Using optical coherence tomography angiography (OCTA) to observe the changes in macular blood flow density and macular thickness in patients with femtosecond laser cataract surgery. Design Retrospective comparative case series. Participants From July 2020 to June 2021, 60 patients (60 eyes) diagnosed with age-related cataract and treated with surgery in Shenzhen Aier Eye Hospital were selected. 30 patients (30 eyes) who underwent femtosecond laser-assisted cataract surgery (femtosecond laser group) and 30 patients (30 eyes) who underwent common phacoemulsification cataract surgery (traditional phacoemulsification group). Methods Patients in each group underwent OCTA examination before surgery, 1 day, 1 week, 1 month, and 3 months after surgery. The superficial retinal blood flow perfusion density in the macular area 3 mm×3 mm (3 mm) and 6 mm×6 mm (6 mm) and the 3 mm macular area of all patients were recorded. Intra-layer and full-layer retinal thickness were measured and compared. Main Outcome Measures Blood flow density and macular thickness. Results Superficial retinal blood flow density in the macular region of 3 mm and 6 mm: femtosecond laser group decreased in 1 day, 1 week and 1 month after surgery compared with that before surgery (P_{(3 mm)}=0.016, 0.014, 0.011, P_{(6 mm)}=0.042, 0.013, 0.007). In traditional phacoemulsification group, the blood flow density decreased in 1 day and 1 week after operation (P_{(3 mm)}=0.033, 0.040, P_{(6 mm)}=0.031, 0.040). The superficial retinal blood flow density in the 3 mm and 6 mm areas in traditional phacoemulsification group was significantly higher than that in the femtosecond laser group at 1 month after surgery (t=3.536, P=0.001; t=3.259, P=0.003). Retinal thickness of 3 mm in macular area: the average thickness of inner and whole retinal in traditional phacoemulsification group increased at 1 month and 3 months after surgery compared with the preoperative thickness (P=0.036, 0.031; P=0.019, 0.016), and showed an increasing trend with time, and tended to be stable at 3 months after surgery. The average thickness of inner retina and whole retina in femtosecond group increased at 1 week, 1 month and 3 months after operation (P=0.045, 0.020, 0.005; P=0.038, 0.027, 0.007), and showed an increasing trend with time, and tended to be stable at 3 months after surgery. There was no significant difference in the average thickness of inner and whole retina between the two groups at each time (all P>0.05). Conclusion The superficial retinal blood flow density and retinal thickness in the macular area of femtosecond laser-assisted cataract surgery patients showed no difference 3 months after surgery compared with traditional phacoemulsification cataract surgery patients. Femtosecond laser-assisted cataract surgery is a safer surgical method. (Ophthalmol CHN, 2024, 33: 99-104)

Key words: femtosecond laser-assisted cataract surgery, macular blood flow density, optical coherence tomography angiography