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

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


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.

Publication types

  • Validation Study

MeSH terms

  • Aberrometry / methods
  • Biometry
  • Corneal Surgery, Laser*
  • Humans
  • Intraoperative Period
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Myopia / surgery*
  • Optics and Photonics*
  • Phacoemulsification*
  • Reproducibility of Results
  • Visual Acuity / physiology