Correlation between phacoemulsfication surgery duration and postoperative cystoid macular edema (on optical coherence tomography)

Abstract

Background: Delayed or suboptimal visual recovery after cataract surgery is an important worry, which includes the occurrence of cystoid macular edema (CME). Phacoemulsification (PE) may induce postoperative changes of the retina by mechanical and inflammatory mechanisms via the ultrasonic energy applied during phacoemulsification. Objective: To determine the correlation between phacoemulsification duration (in seconds) and postoperative central macular thickness (CMT) on optical coherence tomography (OCT) in microns (μm). Methods: This was a Cross-sectional observational study that was carried out at Department of Ophthalmology, DHQ University Teaching Hospital, Gujranwala from April 2026 to July 2026. 60 patients aged between 50–80 years, who underwent uncomplicated phacoemulsification surgery. The phacoemulsification time was documented intraoperatively and a SD-OCT was performed to measure the CMT preoperatively and four weeks after surgery. CME was defined as the presence of cystoid intraretinal spaces and CMT >300 μm or an increase of ≥10% from baseline. Results: The mean phacoemulsification time was 58.4 ± 18.7 seconds. Mean CMT increased from 248.6 ± 22.3 μm preoperatively to 276.9 ± 41.5 μm postoperatively (p < 0.001). Mean ΔCMT was 28.3 ± 35.8 μm. Moderate positive correlation was found between phaco duration and ΔCMT (r = 0.47, p < 0.001). CME developed in 9 eyes (15%). Diabetic patients had greater macular thickening than non-diabetic patients (41.2 ± 38.6 vs 20.7 ± 31.4 μm, p = 0.018). Phaco time independently predicted CME (adjusted OR 1.04, 95% CI 1.01–1.08, p = 0.012). Conclusion: The incidence of CME was related to the duration of phacoemulsification and the amount of postoperative macular thickening. Efficient Transmission of Ultrasonic Energy Can Minimize Macular Complications after Surgery.