Abstract:Objective: To analyze the effect of preoperative retinal ganglion cell complex thickness (GCC) on visual quality after cataract combined with glaucoma surgery. Method: A retrospective study was conducted. Clinical data of 115 patients (115 eyes) with cataract and glaucoma who underwent phacoemulsification, intraocular lens implantation, and angle separation surgery in the hospital were collected from January 2023 to December 2024. Preoperative evaluation of retinal GCC was performed, and the three-point method was used to divide the GCC thickness in the macular area into low thickness group (<70.00 μ m, 31 cases), medium thickness group (70.00-74.00 μ m, 47 cases), and high thickness group (>74.00 μ m, 37 cases). Postoperative visual quality was evaluated by visual acuity, contrast sensitivity, field of view, and subjective visual quality (QoV) at 1 month, 3 months, and 6 months after surgery. Univariate covariance analysis was used to analyze the inter group data of GCC thickness in different macular regions before surgery. Linear regression analysis was used to verify the effect of preoperative macular GCC thickness on postoperative visual acuity at 6 months. Result: Comparative analysis of baseline data among the three patient groups showed no statistically significant differences (P>0.05). However, there were statistically significant differences in visual acuity LogMAR values, contrast sensitivity values, mean visual field deviation values, QoV scores, group effects, time effects, and interaction effects among the groups (P<0.05). There was no statistical significant difference in the LogMAR values, contrast sensitivity values, mean visual field deviation values, and QoV scores among the three groups before surgery (P>0.05). At postoperative months 1, 3, and 6, the low-thickness group exhibited higher visual acuity LogMAR values and QoV scores compared to the medium-and high-thickness groups, with the medium-thickness group showing superior performance to the high-thickness group (P<0.05). The low-frequency, mid frequency, and high-frequency contrast sensitivity values, as well as the average deviation of the field of view, were lower in the low thickness group than in the medium and high thickness groups, and the medium thickness group was lower than the high thickness group, with statistical significant diffwerences (P<0.05). At 1 month, 3 months, and 6 months after surgery, the LogMAR and QoV scores of the three groups of patients decreased compared to preoperative visual acuity, while the contrast sensitivity and visual field average deviation values of low frequency, medium frequency, and high frequency increased, with statistical significant diffwerences (P<0.05). The LogMAR and QoV scores of the three groups of patients were higher at 1 month after surgery than at 3 and 6 months after surgery, with statistical significant diffwerences (P<0.05). The low frequency, mid frequency, and high frequency contrast sensitivity values, as well as the average deviation of the visual field, were all lower in the three groups of patients one month after surgery than at 3 and 6 months after surgery, with statistical significant diffwerences (P<0.05). Through linear regression analysis, the model fit was good (F=53.846, P<0.001), and the thickness of GCC in the macular area before surgery had a negative impact on the LogMAR value of visual acuity at 6 months after surgery (β=-0.006, P<0.001). The regression equation was: Y=0.716-0.006 × X preoperative macular GCC thickness. The model determination coefficient R2=0.323 suggested that preoperative GCC thickness can explain 32.3% of the degree of visual acuity variation at 6 months after surgery. For every 1 μm reduction in the thickness of the GCC before the surgery, the average LogMAR visual acuity value increased by 0.006 at 6 months after the surgery. Conclusion: Preoperative retinal GCC thickness is a protective factor for visual quality after cataract combined with glaucoma surgery. The thicker the preoperative GCC, the better the visual acuity, contrast sensitivity, and visual field recovery at 1, 3, and 6 months after surgery. Moreover, for every 1 μ m decrease in preoperative GCC thickness, the average LogMAR visual acuity value at 6 months after surgery increases by 0.006, which can be used as one of the preoperative predictive indicators for postoperative visual quality.
