Journal de chirurgie des yeux et de la cataracte Libre accès

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Intraoperative Biometry versus Conventional Methods for Predicting Intraocular Lens Power: A Closer Look at Patients Undergoing Toric Lens Implantation for Astigmatic Correction

Emily Waisbren, David Ritterband, Li Wang, Danielle Trief, Richard Koplin and John Seedor

Purpose: To compare intraoperative refractive biometry to conventional methods for intraocular lens (IOL) power calculation in patients receiving toric IOLs.

Setting: The New York Eye and Ear Infirmary of Mt. Sinai.

Design: Retrospective Case Series.

Methods: Separate cohorts of patients undergoing primary cataract extraction with toric IOL implantation were analyzed. In 52 patients, Optivue Refractive Analysis (ORA) was used to guide IOL power determination and axis adjustment. In a separate cohort of 52 patients, conventional methods were used to determine the astigmatic axis and calculate the IOL power. Prediction error (Actual spherical equivalent (SE)-Predicted SE) and median absolute error (MAE) were calculated in each group. The percentage of eyes within ± 0.50 diopters (D) and ± 1.00 D of the refractive target along with the residual cylinder and deviation from intended axis were compared.

Results: The 52 patients in the ORA cohort achieved statistically significant better postoperative MAE than those in the conventional group (MAE 0.34 ± 0.29 (conventional) vs. 0.25 ± 0.22 (ORA), p=0.05). When ORA were used, patients were more likely to fall within 0.5D of the targeted refraction (87% vs. 79%). Residual astigmatism was less than 1D in 87% of the ORA group compared to 69% of the conventional group. In the ORA group, 29% of eyes ended up within 10 degrees of the intended axis compared to 12% of eyes in the conventional group.

Conclusions: The current study shows that intraoperative biometry significantly improves refractive target outcomes for patients undergoing toric IOL implantation in comparison to conventional methodology.