Posters

Intraoperative wavefront aberrometry for toric intraocular lens placement in eyes with a history of refractive surgery

Poster Details

First Author: S. Palioura UNITED STATES

Co Author(s):    N. Yesilirmak   W. Culbertson   S. Yoo   K. Donaldson           

Abstract Details

Purpose:

To assess the value of intraoperative wavefront aberrometry for toric intraocular lens (IOL) implantation in eyes undergoing cataract surgery after prior refractive surgery.

Setting:

The Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, a tertiary ophthalmology referral center in South Florida, USA.

Methods:

Retrospective review of 15 post-refractive eyes that underwent cataract surgery with toric IOL implantation. The Optiwave Refractive Analysis (ORA) system was used to obtain aphakic refractions intraoperatively. The ORA predictive accuracy was compared to the IOL power predicted by: a. the SRK-T formula using axial length measurements from the IOLMaster and keratometry values, and b. the American Society of Cataract and Refractive Surgery (ASCRS) online calculator. Main outcome measures were the mean absolute error of prediction and percentage of eyes within ± 0.25 diopters (D), ± 0.50 D, ± 0.75 D and ± 1.00 D of refractive prediction error.

Results:

The ORA mean absolute prediction error was 0.43 ± 0.33D, compared to a mean prediction error of 0.77 ± 0.56D for the calculated preoperative lens choice according to the IOLMaster (p value, 0.03) and 0.61 ± 0.34D according to the ASCRS calculator (p value, 0.08). The prediction error was ≤ 0.25 D in 46% of eyes, ≤ 0.50 D in 58%, ≤ 0.75 D in 78%, and ≤ 1.00 D in 90% of eyes with ORA, compared to 20%, 40%, 53% and 65% according to IOLMaster and 13%, 39%, 72% and 84% according to the ASCRS calculator.

Conclusions:

Though uncommon for eyes with history of refractive surgery to have significant residual corneal astigmatism, such cases do exist and present an extra challenge. Use of a toric intraocular lens could aid in achieving a spherical equivalent of less than 0.50 D, as long as its power and axis of placement are selected accurately. Herein, we show that the ORA system could accurately predict toric IOL power in challenging post-refractive eyes.

Financial Disclosure:

NONE