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Moderator
Stephen D. Klyce, PhD
Panelists
Maria S. Romero, MD, ABO
Anitha Venugopal, MBBS, DNB
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors, and view the full session above.
Presenting Author
Alivia Ankrum, BSc
Co-Authors
Vance Thompson MD, Tanner Ferguson MD
Purpose
To evaluate visual and refractive outcomes of patients with prior Verisyse pIOL placement that underwent concomitant pIOL explantation and cataract surgery with implantation of a light-adjustable lens (LAL).
Methods
Retrospective case series of eyes with a history of Verisyse pIOL placement that underwent combined pIOL explanation and cataract removal with implantation of the light-adjustable lens (LAL). Primary outcomes included uncorrected and corrected distance visual acuity, mean refractive spherical equivalent and the percentage of eyes within ±0.5 and ±1.0 D of target.
Results
10 eyes from six patients were included in this study. Seven eyes also had a prior history of refractive surgery, all of which were LASIK. In eyes targeted for plano, 75% (n=6) achieved UDVA of 20/20 or better and 100% (n=8) achieved an UDVA of 20/30 or better. 90% (n=9) of eyes were correctable to 20/20 or better post-operatively, with 100% achieving a corrected visual acuity of 20/25 or better. For refractive outcomes, 90% (n=9) of eyes were within ±0.25 D of their refractive target outcome.
Conclusion
Motivated patients with a history of pIOL implantation can achieve favorable visual and refractive outcomes with cataract surgery with the LAL. The adjustable nature of the LAL helps to overcome changes in refractive astigmatism following pIOL explantation and the large corneal incision.
Presenting Author
Tanner J. Ferguson, MD
Co-Authors
Vance Thompson MD, John Berdahl MD, Kayla Karpuk OD
Purpose
To evaluate the accuracy of IOL power calculations in eyes with a history of laser corneal refractive surgery using sum-of-segments biometry (ARGOS)
Methods
Prospective, single-site study evaluating refractive outcomes using sum-of-segments biometry for patients undergoing cataract surgery. Subjects with a history of myopic corneal refractive surgery with implantation of a monofocal IOL were enrolled. All patients enrolled had measurements using sum-of-segments biometry and calculations were performed with the Barrett True-K calculator. Outcome measures included the percentage of eyes with refractive prediction error within ±0.25, ±0.50 and ±1.00 D of target, mean absolute error (MAE) and median absolute error (MedAE).
Results
30 eyes from 15 subjects with a history of myopic corneal refractive surgery were included in the series. The average age was 68.1 ± 4.6 years. 22/30 (73%) of eyes were targeted for emmetropia while 8/30 had a near or intermediate target. The percentage of eyes within ±0.25 D, ±0.50 and ±1.00 of target was 43%, 73% and 90%, respectively. The MAE was 0.43 D and the MedAE was 0.36 D.
Conclusion
Sum-of-segments biometry provides favorable IOL power accuracy in eyes with a history of corneal laser refractive surgery.
Presenting Author
Amit Gupta, MS
Co-Authors
Chintan Malhotra MS, Byanjana Bashyal MD
Purpose
To report refractive outcomes of cataract surgery using Intraoperative Biometry with ORA (Optiwave Refractive Analysis) in Post-Radial Keratotomy (RK) eyes.
Methods
Study Design: Retrospective consecutive case series. Participants:32 eyes (24 patients) undergoing cataract surgery post radial keratotomy. Manifest refraction, uncorrected visual acuity, BCVA, a slit-lamp examination; and Pentacam Scheimpflug imaging done. Optical biometry was performed using partial coherence interferometry (IOLMaster version 7, Carl Zeiss Meditec AG) for Haigis L and Barretts True-K formula. The IOL that had the desired residual myopic outcome was chosen for implantation. Intraoperatively - ORA (Optiwave Refractive Analysis) was done for IOL power estimation intraoperatively. Refractive outcomes and predictive accuracy with ORA was calculated.
Results
Main outcome measures Percentage of eyes within ± 0.50 diopters (D), ± 1.00 D and ± 2.00 D of predicted IOL power, Residual Refractive (mean absolute) prediction error within SE target. All eyes were 20/70 or better, 19 (60 %) eyes were 20/50 or better. Preoperative versus postoperative, mean spherical refractive error was - 4.95 ± 5.40 D versus 0.98 ± 1.12, MRSE was – 6.59 ± 5.40 versus – 0.38 ± 0.45, cylinder was -2.85 ± 1.65 D versus -2.38 ± 1.76. Mean absolute prediction error was 0.43±0.34 D with ORA versus 0.73±0.56 D (p=0.07). ORA recommended IOL values were ≤ ±0.5 D in 80% and ≤ ± 1.0 D in 100% eyes compared to 36% ≤ ±0.5 D, 72 % ≤ ±1.0 D and 100 % ≤ ± 2 D.
Conclusion
Optiwave Refractive Analysis (ORA) significantly improves the refractive outcomes of cataract surgery in post RK eyes. (complicated scenarios) Significant improvement in refractive outcomes and predictive accuracy in Post-Radial keratotomy eyes undergoing cataract surgery using ORA as compared to 4th generation IOL formulas.
Presenting Author
Eric R. Chen, MD
Co-Authors
Karim Kozhaya MD, Dylan McBee BSc, Li Wang MD, PhD, Mitchell Weikert MD, MS, Allison Chen MD, MPH, Douglas Koch MD
Purpose
To assess the performance of ray tracing and artificial intelligence (AI) formulas in normal and myopic LASIK (M-LASIK) eyes
Methods
Measurements from two swept-source optical coherence tomography biometers, the Anterion (Heidelberg Engineering) and the IOLMaster 700 (Carl Zeiss Meditec), were collected. Refractive prediction errors (RPEs) were calculated for the following formulas: Okulix (2.5 and 4.0mm pupil size), ZEISS AI v2.0, Barrett Universal II (Average K and True K readings in normal eyes) and Barrett True-K (BTK, predicted and measured posterior cornea power in M-LASIK eyes). Monofocal lenses were included. The RPE standard deviations (SDs), mean numerical error (MNE) and percentages of eyes within prediction errors of ±0.25 diopters (D), ±0.50 D, ±0.75 D, and ±1.00 D were assessed.
Results
The study is comprised of 141 normal eyes from 141 patients, and 56 M-LASIK eyes from 42 patients. Preliminary results with the ZEISS AI v1.0 were included in normal eyes only. For normal eyes, only the ZEISS AI v1.0 had a MNE (-0.12 D) that was significantly different from 0 (p<0.05), and no difference in RPE SDs and refractive accuracy was reported among all formulas. For M-LASIK eyes, preliminary results compared Okulix 2.5, Okulix 4.0, BTK measured and BTK predicted, with only the latter formula having a MNE (-0.22 D) significantly different from 0 (p<0.05). No difference in RPE SDs and refractive accuracy was reported among these formulas in M-LASIK eyes.
Conclusion
TBD. MNE, RPE SDs and percentage of eyes within prediction errors for ZEISS AI v2.0 will be calculated for normal and M-LASIK eyes when the formula is released and available.
