Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in short eyes.

PURPOSE: To compare the accuracy of preoperative biometry-based formulas to intraoperative aberrometry (IA) with respect to predicting refractive outcomes after cataract surgery in short eyes. SETTING: Private practice and community-based ambulatory surgery center. DESIGN: Retrospective consecutive case series. METHODS: Eyes with an axial length (AL) shorter than 22.1 mm underwent cataract extraction and intraocular lens (IOL) implantation. The predicted residual refractive error was calculated preoperatively using Hoffer Q, Holladay 2, Haigis, Barrett Universal II, and Hill-RBF formulas and intraoperatively using IA. The postoperative spherical equivalent (SE) was compared with the predicted SE to evaluate the accuracy of each aforementioned method. RESULTS: Fifty-one eyes from 38 patients met criteria to be included in the analysis. Without optimizing the formulas specifically for short eyes, the mean numerical errors (MNEs) associated with Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, and IA were -0.08 (95% confidence interval [CI], -0.30 to 0.13), -0.14 (95% CI, -0.35 to 0.07), +0.26 (95% CI, 0.05 to 0.47), +0.11 (95% CI, -0.10 to 0.32), +0.07 (95% CI, -0.14 to 0.28), and +0.00 (95% CI, -0.21 to 0.21), respectively (P < .001). The proportion of eyes within ±0.5 diopter (D) of the predicted SE were 49.0%, 43.1%, 52.9%, 52.9%, 60.8%, and 58.8%, respectively (P = .06). The prediction outcomes from IA were statistically better than Haigis, but not other formulas. When formula and IA predictions differed by 0.5 D or more, IA's ability to recommend a more emmetropic outcome was no better than chance (50%). CONCLUSIONS: Intraoperative aberrometry is not significantly different from the best preoperative biometry-based methods available for IOL power selection in short eyes.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in axial myopia.

PURPOSE: To compare the accuracy of intraoperative wavefront aberrometry (ORA) and the Hill-radial basis function (RBF) formula with other formulas based on preoperative biometry in predicting residual refractive error after cataract surgery in eyes with axial myopia. SETTING: Private practice, Harrisburg, Pennsylvania, USA. DESIGN: Retrospective consecutive case series. METHODS: Eyes with an axial length (AL) greater than 25.0 mm had cataract extraction with intraocular lens implantation. For each eye, the 1-center Wang-Koch AL-optimized Holladay 1 formula was used to select an IOL targeting emmetropia. Residual refractive error was predicted preoperatively using the SRK/T, Holladay 1 and 2, Barrett Universal II, and Hill-RBF formulas and intraoperatively using wavefront aberrometry. The postoperative refraction was compared with the preoperative and intraoperative predictions. RESULTS: The study comprised 37 patients (51 eyes). The mean numerical errors ± standard error associated with using the SRK/T, Holladay 1, AL-optimized Holladay 1, Holladay 2, Barrett Universal II, and Hill-RBF formulas and intraoperative wavefront aberrometry were 0.20 ± 0.06 diopters (D), 0.33 ± 0.06 D, -0.02 ± 0.06 D, 0.24 ± 0.06 D, 0.19 ± 0.06 D, 0.22 ± 0.06 D, and 0.056 ± 0.06 D, respectively (P < .001). The proportion of patients within ±0.5 D of the predicted error was 74.5%, 62.8%, 82.4%, 79.1%, 73.9%, 76.7%, and 80.4%, respectively (P = .090). Hyperopic outcomes occurred in 70.6%, 76.5%, 49.0%, 74.4%, 76.1%, 74.4%, and 45.1% of the eyes, respectively (P = .007). CONCLUSIONS: Intraoperative wavefront aberrometry was better than all formulas based on preoperative biometry and as effective as the AL-optimized Holladay 1 formula in predicting residual refractive error and reducing hyperopic outcomes. The Hill-RBF formula's performance was similar to that of the fourth-generation formulas.