Intraoperative Refractive Biometry for Predicting Intraocular Lens Power Calculation after Prior Myopic Refractive Surgery

doi:10.1016/j.ophtha.2013.08.041

Ophthalmology

Volume 121, Issue 1, January 2014, Pages 56-60

https://doi.org/10.1016/j.ophtha.2013.08.041 Get rights and content

Purpose

To evaluate a new method of intraoperative refractive biometry (IRB) for intraocular lens (IOL) power calculation in eyes undergoing cataract surgery after prior myopic LASIK or photorefractive keratectomy.

Design

Retrospective consecutive cases series.

Participants

We included 215 patients undergoing cataract surgery with a history of myopic LASIK or photorefractive keratectomy.

Methods

Patients underwent IRB for IOL power estimation. The Optiwave Refractive Analysis (ORA) System wavefront aberrometer was used to obtain aphakic refractive measurements intraoperatively and then calculate the IOL power with a modified vergence formula obtained before refractive surgery. Comparative effectiveness analysis was done for IRB predictive accuracy of IOL power determination against 3 conventional clinical practice methods: surgeon best preoperative choice (determined by the surgeon using all available clinical data), the Haigis L, and the Shammas IOL formulas.

Main Outcome Measures

Median absolute error of prediction and percentage of eyes within ±0.50 diopters (D) and ±1.00 D of refractive prediction error.

Results

In 246 eyes (215 first eyes and 31 second eyes) IRB using ORA achieved the greatest predictive accuracy (P < 0.0001), with a median absolute error of 0.35 D and mean absolute error of 0.42 D. Sixty-seven percent of eyes were within ±0.5 D and 94% were within ±1.0 D of the IRB's predicted outcome. This was significantly more accurate than the other preoperative methods: Median absolute error was 0.6, 0.53, and 0.51 D for surgeon best choice, Haigis L method, and Shammas method, respectively.

Conclusions

The IOL power estimation in challenging eyes with prior LASIK/photorefractive keratectomy was most accurately predicted by IRB/ORA.

Section snippets

Methods

The study involved 66 investigators who were trained users of the ORA System intraoperative aberrometer for IOL calculation. The study protocol was exempted from review by an independent review board in accordance with US Code of Federal Regulations 45 CFR 46.101(b). Patients who met the criteria of operable cataract in the setting of prior myopic LASIK or photorefractive keratectomy and absence of significant ocular comorbidities were queried from the ORA surgical outcomes database, which

Results

A total of 246 consecutive eyes from 215 patients were included in the series. Thirty-one eyes were fellow follow-on eye surgeries. All had undergone myopic LASIK or photorefractive keratectomy surgery before their cataract surgery. The baseline ocular characteristics of the study cohort are summarized in Table 1. The study population had a broad representative range of anatomic variability, with AL ranging from 21.50 to 30.23 mm and average K from 34.13 to 46.95 D. Also, the power of the

Discussion

Our study reports the largest series of outcomes using IRB for IOL power calculation based on the ORA System intraoperative wavefront aberrometer. It is also among the largest outcome studies of IOL power prediction after prior keratorefractive surgery. The results from 246 consecutive eyes demonstrate improved predictive accuracy of IOL power estimation using the Talbot-Moiré IRB compared with conventional preoperative methodologies. These favorable composite results were obtained with a large

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Accuracy of the PEARL-DGS Formula for Intraocular Lens Power Calculation in Post–Myopic Laser Refractive Corneal Surgery Eyes
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To investigate the accuracy of the PEARL-DGS formula for intraocular lens (IOL) power calculation in post–myopic laser refractive corneal surgery eyes.
Retrospective case series.
A total of 139 eyes of 139 patients (mean axial length: 27.4 ± 2.1 mm) who had prior myopic laser refractive corneal surgery and subsequent cataract surgery using Tecnis ZCB00 from March 2018 to February 2023 were included. Refractive outcomes of 5 formulas (Barrett True K, Haigis-L, Hoffer-QST, PEARL-DGS, and Shammas-PL) were evaluated. Prediction error was defined as the difference between the measured and predicted postoperative refractive spherical equivalent using the IOL power actually implanted. Mean prediction error (MPE), median absolute prediction error (MedAE), and mean absolute prediction error were calculated.
Without constant optimization, the PEARL-DGS resulted in a MPE of +0.05 ± 0.65 diopters (D), whereas the other formulas resulted in myopic shifts. The MedAEs of the formulas were 0.39, 0.53, 0.65, 0.85, and 1.11 D for the PEARL-DGS, Hoffer-QST, Barrett True K, Shammas-PL, and Haigis-L, respectively, in order of magnitude (P < .05). With constant optimization, there were no statistically significant differences in the MedAEs among the 5 formulas (P = .388).
In comparison to other IOL formulas, the PEARL-DGS resulted in better refractive outcomes after cataract surgery in post–myopic laser refractive corneal surgery eyes without constant optimization. We suggest that PEARL-DGS be considered as the first choice for IOL power calculation in these eyes when the clinicians do not have their optimized constants.
Evaluation and Management of Postoperative Complications Following Cataract Extraction and Intraocular Lens Placement
2024, Advances in Ophthalmology and Optometry
Prediction accuracy of intraoperative aberrometry compared with preoperative biometry formulae for intraocular lens power selection
2023, Canadian Journal of Ophthalmology
To compare the accuracy of intraoperative wavefront aberrometry to preoperative biometry formulae for predicting intraocular lens power.
Retrospective, consecutive case series.
Eyes undergoing cataract extraction with at least 1 month of follow-up after surgery at an ambulatory surgical centre in Toronto.
Consecutive sample of 228 cataract extractions with monofocal, trifocal, or toric intraocular lens implantation from November 1, 2017, to December 31, 2019. The spherical equivalent was predicted preoperatively with Barrett Universal II, Hill-Radial Basis Function (RBF), SRK/T, Holladay I, Holladay II, Haigis, and HofferQ using biometry measurements and intraoperatively with wavefront aberrometry. The primary outcomes were mean prediction error and proportion of eyes with a spherical equivalent within 0.5 D of the refractive target at postoperative month 1.
The analysis included 159 eyes with 52% females and a mean age of 69.4 years. Formulae with the lowest mean prediction error were Hill-RBF (0.32 D ± 0.02 D), Barrett Universal II (0.32 D ± 0.02 D), intraoperative aberrometry (0.32 D ± 0.02 D), SRK/T (0.33 D ± 0.02 D), Holladay II (0.34 D ± 0.03 D), Holladay I (0.35 D ± 0.02 D), Haigis (0.37 D ± 0.02 D), and HofferQ (0.42 D ± 0.02 D). There were no statistically significant differences between intraoperative aberrometry and the preoperative formulae. Formulae with the highest proportion of eyes within 0.5 D of the refractive target were intraoperative aberrometry (82%), Barrett Universal II (81%), Hill-RBF (80%), SRK/T (77%), Holladay II (76%), Holladay I (75%), Haigis (71%), and HofferQ (70%).
Intraoperative aberrometry and modern preoperative biometry formulae are equally effective at reaching the refractive target. In normal eyes, intraoperative aberrometry does not appear to provide any additional benefit to modern prediction formulae.
Comparer la précision de l'aberrométrie du front d'onde peropératoire à celle des formules de biométrie préopératoire quant à la prédiction de la puissance des lentilles intraoculaires.
Étude rétrospective d'une série de cas consécutifs.
Yeux ayant fait l'objet d'une extraction de cataractes pour lesquels on disposait d'un suivi postopératoire d'au moins 1 mois dans un centre de chirurgie d'un jour à Toronto.
Échantillon de 228 extractions de cataractes consécutives s'accompagnant de l'implantation d'une lentille intraoculaire monofocale, trifocale ou torique réalisées entre le 1^er novembre 2017 et le 31 décembre 2019. L’équivalent sphérique a été estimé avant l'intervention grâce aux mesures de biométrie générées par diverses formules (Barrett Universal II, Hill-RBF [Radial Basis Function], SRK/T, Holladay I, Holladay II, Haigis et HofferQ), d'une part, et pendant l'intervention grâce à l'aberrométrie du front d'onde, d'autre part. Les principaux paramètres de mesure étaient l'erreur moyenne de prédiction et la proportion d'yeux dont l’équivalent sphérique se situait dans les limites de 0,5 D de la cible réfractive 1 mois après l'intervention.
L'analyse portait sur 159 yeux (52 % de femmes; âge moyen : 69,4 ans). La technique de mesure à l'erreur moyenne de prédiction la plus faible était la formule Hill-RBF (0,32 D ± 0,02 D), suivie de la formule Barrett Universal II (0,32 D ± 0,02 D), de l'aberrométrie peropératoire (0,32 D ± 0,02 D) et des formules SRK/T (0,33 D ± 0,02 D), Holladay II (0,34 D ± 0,03 D), Holladay I (0,35 D ± 0,02 D), Haigis (0,37 D ± 0,02 D) et HofferQ (0,42 D ± 0,02 D). On n'a pas enregistré de différence statistiquement significative entre l'aberrométrie peropératoire et les formules préopératoires. La technique de mesure qui a prédit la plus grande proportion d'yeux dans les limites de 0,5 D de la cible réfractive était l'aberrométrie peropératoire (82 %), suivie des formules Barrett Universal II (81 %), Hill-RBF (80 %), SRK/T (77 %), Holladay II (76 %), Holladay I (75 %), Haigis (71 %) et HofferQ (70 %).
L'aberrométrie peropératoire et les formules modernes de biométrie préopératoire sont aussi efficaces les unes que les autres pour ce qui est d'atteindre la cible réfractive. Dans les yeux normaux, l'aberrométrie peropératoire ne semble pas présenter d'avantages supplémentaires par rapport aux formules modernes de prédiction.
Corneal Topography for Intraocular Lens Selection in Refractive Cataract Surgery
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The purpose of this review is to evaluate the usefulness of corneal topography to select premium intraocular lenses (IOLs), including aspherical IOLs, toric IOLs, and multifocal IOLs, in refractive cataract surgery. Corneal topography can detect corneal regular astigmatism, corneal irregular astigmatism (higher-order aberrations [HOAs]) including spherical aberration, and corneal shape abnormalities after corneal refractive surgery. Surgeons can explain to the patients with significant corneal HOAs about its effect on postoperative visual function before surgery. Multifocal IOLs should not be selected for such eyes. For eyes with abnormal corneal shape, appropriate IOL power calculation formulae can be applied. In the case of toric IOLs, regular astigmatism and corneal HOAs should be checked. Before implanting an aspheric IOL, it is ideal to confirm spherical aberration of the cornea is not below the normal range. Because corneal HOAs, abnormal corneal shape after corneal refractive surgery, corneal regular astigmatism, and corneal spherical aberration increase postoperative refractive errors and poor vision quality with premium IOLs, corneal topography before cataract surgery is helpful in screening patients who are not appropriate candidates for premium IOLs.
Camellin-Calossi Formula for Intraocular Lens Power Calculation in Patients With Previous Myopic Laser Vision Correction
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An update on intraocular lens power calculations in eyes with previous laser refractive surgery
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: Financial Disclosures: The authors have made the following disclosures:

Tsontcho Ianchulev: Consultant—WaveTec Vision, Inc.

Michael Breen: Financial support—WaveTec Vision, Inc.

Thomas Padrick: Financial support—WaveTec Vision, Inc.

Dan B. Tran: Financial support, Consultant—WaveTec Vision, Inc; Consultant—Alcon, ReVision Optics, Transcend Medical, and Bausch & Lomb

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Original articleIntraoperative Refractive Biometry for Predicting Intraocular Lens Power Calculation after Prior Myopic Refractive Surgery

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Original article
Intraoperative Refractive Biometry for Predicting Intraocular Lens Power Calculation after Prior Myopic Refractive Surgery