Macular vessel density in highly myopic eyes with a history of uncomplicated cataract surgery: a cross-sectional OCTA study

High myopia is associated with structural and microvascular retinal alterations. However, macular microvascular characteristics in highly myopic eyes with a history of cataract surgery remain insufficiently characterized, particularly in comparison with non-operated highly myopic eyes. This study aimed to compare macular optical coherence tomography angiography (OCTA) parameters between highly myopic eyes with and without a history of uncomplicated cataract surgery. This cross-sectional, observational study included 61 eyes of 37 highly myopic patients who underwent uncomplicated cataract surgery as the study group and 71 eyes of 42 non-operated highly myopic patients as the control group. Retinal vascular structures in the macular regions were examined in detail and quantitatively assessed using optical coherence tomography and OCTA. Data from these two groups were compared. There were no statistically significant differences between the groups in terms of age, sex, best corrected visual acuity, or axial length. The mean surgery-to-imaging interval in the study group was 18.2 months. Significantly lower superficial and deep capillary plexus vessel density was observed in most evaluated macular regions in the study group compared with the control group. However, no significant difference was found in the foveal avascular zone area between the groups ( p = 0.808). Highly myopic eyes with a history of uncomplicated cataract surgery had lower macular vessel density than non-operated highly myopic eyes at a later postoperative assessment. Because of the cross-sectional design, these findings represent between-group differences and do not establish postoperative change or a causal effect of cataract surgery. Further longitudinal studies are needed to determine the clinical significance of these vascular differences and their potential relationship with visual function.