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Ophthalmology. 2014 Jan;121(1):56-60. doi: 10.1016/j.ophtha.2013.08.041. Epub 2013 Oct 30.

Intraoperative refractive biometry for predicting intraocular lens power calculation after prior myopic refractive surgery.

Author information

  • 1University of California at San Francisco, San Francisco, California. Electronic address: tianchul@yahoo.com.
  • 2Department of Ophthalmology, University of California at Los Angeles, Los Angeles, California; St. Mary's Eye Center, Santa Monica, California.
  • 3Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
  • 4Department of Ophthalmology, University of California at San Francisco, San Francisco, California.
  • 5WaveTec Vision, Inc, Aliso Viejo, California.
  • 6Private Practice, Long Beach, Orange, and Newport Beach, California.

Abstract

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.

Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID:
24183339
[PubMed - indexed for MEDLINE]
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