{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:41:13Z","timestamp":1760575273865,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Preperimetric glaucoma (PPG) is characterized by structural optic nerve damage without detectable functional impairment. Optical coherence tomography (OCT) is increasingly utilized to monitor glaucoma, though its reliability can be compromised by lens opacities. This study investigates retinal nerve fiber layer (RNFL) thickness changes after cataract surgery in patients with and without PPG, aiming to assess potential diagnostic inaccuracies due to cataract-induced imaging artifacts. Methods: Thirty eyes from 30 patients undergoing cataract surgery were analyzed, divided into two groups: Group 1 (n = 15) without glaucoma and Group 2 (n = 15) with PPG diagnosed using the Global Glaucoma Staging System. RNFL thickness was measured using Spectral-Domain OCT before and one month after phacoemulsification. Statistical analysis was performed using SPSS v23.0. Results: Postoperative RNFL thickness increased significantly in both groups, with a greater mean change in the PPG group (mean increase: 13 \u00b5m vs. 7 \u00b5m in controls; p &lt; 0.00001). The greatest changes were observed in the inferior quadrants (p &lt; 0.001). Image quality improved by approximately 34% post-surgery (p &lt; 0.001). Despite higher postoperative RNFL values, none of the PPG eyes were reclassified as normal. Conclusions: In eyes with mild nuclear cataract, lens-related signal attenuation reduces absolute RNFL values but, in this cohort, had negligible impact on structural diagnostic classification. OCT-based structural findings in early glaucoma should therefore be interpreted with caution in the presence of cataract\u2014recognizing that measurement bias may alter thickness values without changing PPG classification. Cataract surgery improves OCT reliability and can refine subsequent glaucoma assessment.<\/jats:p>","DOI":"10.3390\/jcm14207255","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"7255","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retinal Nerve Fiber Layer Changes Following Cataract Surgery in Patients with and Without Preperimetric Glaucoma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4347-6573","authenticated-orcid":false,"given":"Feliciana","family":"Menna","sequence":"first","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019 Terracina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3513-5826","authenticated-orcid":false,"given":"Laura","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Dental Science and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9677-2519","authenticated-orcid":false,"given":"Mattia","family":"Calabro","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019 Terracina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Meduri","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Dental Science and of Morphological and Functional Images, University of Messina, 98122 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9962-7489","authenticated-orcid":false,"given":"Stefano","family":"Lupo","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019 Terracina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8363-5866","authenticated-orcid":false,"given":"Enzo Maria","family":"Vingolo","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, U.O.C. Ophthalmology, Sapienza University of Rome, Via Firenze 1, 04019 Terracina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1001\/jama.2014.3192","article-title":"The pathophysiology and treatment of glaucoma: A review","volume":"311","author":"Weinreb","year":"2014","journal-title":"JAMA"},{"key":"ref_2","first-page":"4437","article-title":"Detection of glaucoma progression with Stratus OCT retinal nerve fiber layer, optic nerve head, and macular thickness measurements","volume":"46","author":"Medeiros","year":"2005","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1177\/112067219600600411","article-title":"Clinical use of a new method for visual field damage classification in glaucoma","volume":"6","author":"Brusini","year":"1996","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/archopht.120.6.701","article-title":"Gordon, M.O.; Ocular Hypertension Treatment Study Group. The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma","volume":"120","author":"Kass","year":"2002","journal-title":"Arch. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1111\/j.1755-3768.2012.02514.x","article-title":"The relationship between the optical density of cataract and its influence on retinal nerve fibre layer thickness measured with spectral-domain optical coherence tomography","volume":"91","author":"Kok","year":"2013","journal-title":"Acta Ophthalmol."},{"key":"ref_6","first-page":"1165","article-title":"Influence of cataract on optical coherence tomography image quality and retinal thickness","volume":"91","author":"Faber","year":"2007","journal-title":"Br. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/02713680600646882","article-title":"The effect of phacoemulsification cataract surgery on the measurement of retinal nerve fibre layer thickness using optical coherence tomography","volume":"31","author":"Appaswamy","year":"2006","journal-title":"Curr. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1136\/bjo.2004.052498","article-title":"Correlation between retinal nerve fibre layer thickness and optic nerve head size: An optical coherence tomography study","volume":"89","author":"Savini","year":"2005","journal-title":"Br. J. Ophthalmol."},{"key":"ref_9","first-page":"494","article-title":"Influence of lens opacification on retinal nerve fibre layer thickness measurements with optical coherence tomography","volume":"23","author":"Baraibar","year":"2009","journal-title":"Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16067","DOI":"10.1038\/nrdp.2016.67","article-title":"Primary open-angle glaucoma","volume":"2","author":"Weinreb","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.ophtha.2011.10.010","article-title":"Retinal nerve fiber layer imaging with spectral-domain optical coherence tomography: A prospective analysis of age-related loss","volume":"119","author":"Leung","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_12","first-page":"875","article-title":"Ability of Cirrus HD-OCT optic nerve head parameters to detect glaucoma: Influence of optic disc size","volume":"52","author":"Mwanza","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_13","first-page":"351","article-title":"Influence of physiological factors on spectral-domain OCT measurements in healthy subjects","volume":"23","author":"Oddone","year":"2014","journal-title":"J. Glaucoma"},{"key":"ref_14","first-page":"2247","article-title":"Evaluation of progressive retinal nerve fiber layer loss as a diagnostic test for glaucoma","volume":"119","author":"Medeiros","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ophtha.2010.06.036","article-title":"Ability of Cirrus HD-OCT optic nerve head parameters to discriminate normal from glaucomatous eyes","volume":"118","author":"Mwanza","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/archopht.1993.01090060119035","article-title":"The Lens Opacities Classification System III (LOCS III)","volume":"111","author":"Chylack","year":"1993","journal-title":"Arch. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1167\/iovs.09-3468","article-title":"Evaluation of retinal nerve fiber layer progression in glaucoma: A study on optical coherence tomography guided progression analysis","volume":"51","author":"Leung","year":"2010","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_18","first-page":"905","article-title":"Influence of cataract on retinal nerve fibre layer thickness measurement by Stratus optical coherence tomography","volume":"20","author":"Savini","year":"2006","journal-title":"Eye"},{"key":"ref_19","first-page":"1709","article-title":"Effect of cataract on the measurements of spectral-domain optical coherence tomography","volume":"118","author":"Rao","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"114","DOI":"10.3341\/kjo.2016.30.2.114","article-title":"Longitudinal changes in retinal nerve fiber layer thickness after intravitreal anti-vascular endothelial growth factor therapy","volume":"30","author":"Jo","year":"2016","journal-title":"Korean J. Ophthalmol."},{"key":"ref_21","first-page":"116","article-title":"Influence of cataract on time domain and spectral domain OCT retinal nerve fiber layer measurements","volume":"21","author":"Kim","year":"2012","journal-title":"J. Glaucoma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4103\/ojo.OJO_93_2016","article-title":"Effect of phacoemulsification on measurement of retinal nerve fiber layer and optic nerve head parameters using spectral-domain optical coherence tomography","volume":"10","author":"Jha","year":"2017","journal-title":"Oman J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.ajo.2010.09.015","article-title":"Interocular symmetry in peripapillary retinal nerve fiber layer thickness measured with the Cirrus HD-OCT in healthy eyes","volume":"151","author":"Mwanza","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","first-page":"4970","article-title":"Peripapillary retinal nerve fiber layer thickness measurements using swept-source optical coherence tomography and optical coherence tomography angiography in glaucoma","volume":"56","author":"Akagi","year":"2015","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_25","first-page":"116","article-title":"Changes in the peripapillary retinal nerve fiber layer thickness after cataract surgery as measured by spectral-domain optical coherence tomography","volume":"21","author":"Park","year":"2012","journal-title":"J. Glaucoma"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"ORSF37","DOI":"10.1167\/iovs.13-12784","article-title":"Age-related changes in the visual pathways: Blame it on the axon","volume":"54","author":"Calkins","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/01.ijg.0000212294.31411.92","article-title":"Three- and five-year changes in intraocular pressures after clear corneal phacoemulsification in open-angle glaucoma patients, glaucoma suspects, and normal patients","volume":"15","author":"Shingleton","year":"2006","journal-title":"J. Glaucoma"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/j.ophtha.2015.03.021","article-title":"The effect of phacoemulsification on intraocular pressure in glaucoma patients: A report by the American Academy of Ophthalmology","volume":"122","author":"Chen","year":"2015","journal-title":"Ophthalmology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1016\/j.ophtha.2012.02.050","article-title":"Reduction in intraocular pressure after cataract extraction: The Ocular Hypertension Treatment Study","volume":"119","author":"Mansberger","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.ajo.2008.05.032","article-title":"Enhanced depth imaging spectral-domain optical coherence tomography","volume":"146","author":"Spaide","year":"2008","journal-title":"Am. J. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7255\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T12:24:47Z","timestamp":1760531087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":30,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207255"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207255","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}