Quantitative optical coherence tomography angiography analysis of retinal capillary plexuses in diabetic eyes: Impact of phakic and pseudophakic status

Background: Optical coherence tomography angiography (OCTA) has revolutionized the evaluation of retinal microvasculature by enabling noninvasive quantification of capillary networks and the foveal avascular zone (FAZ). Diabetic retinopathy (DR) is associated with progressive microvascular rarefaction, but the effect of lens status on OCTA-derived vascular metrics remains underexplored. Methods: In this prospective observational study, 107 diabetic eyes imaged between March and August 2025 at Drashti Netralaya underwent high-resolution OCTA using the Heidelberg Spectralis platform. OCTEVA software enabled automated segmentation of the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP). Quantitative measurements included vessel area density, branchpoint density, fractal dimension, and FAZ area. Lens status was classified as phakic or pseudophakic. Between-group comparisons were performed using Mann–Whitney U tests with Holm correction for multiple comparisons, and Cohen’s d was calculated for effect size. Results: Pseudophakic eyes exhibited significantly reduced vascular density (SCP: 44.7 ± 6.2% vs 48.5 ± 5.9%, P = 0.004; ICP: 33.8 ± 4.5% vs 36.7 ± 4.3%, P = 0.008; DCP: 34.2 ± 4.9% vs 37.9 ± 5.1%, P = 0.005) and lower fractal dimension (SCP: 1.39 ± 0.06 vs 1.42 ± 0.05, P = 0.011). FAZ area was significantly larger in pseudophakic eyes (0.37 ± 0.09 mm² vs 0.32 ± 0.08 mm², P = 0.018). Central macular thickness was slightly increased in pseudophakic eyes but not statistically significant ( P = 0.07). Conclusion: Pseudophakic eyes demonstrate measurable microvascular compromise and FAZ enlargement compared with phakic eyes, reflecting advanced diabetic disease burden. Lens status should be considered when interpreting OCTA biomarkers in DR research and clinical assessment.