Anterior Segment Changes and Refractive Outcomes after Cataract Surgery Combined with Gonioscopy-Assisted Transluminal Trabeculotomy in Open-Angle Glaucoma

Turk J Ophthalmol. 2023 Dec 21;53(6):369-376. doi: 10.4274/tjo.galenos.2023.36080. Epub 2023 Dec 4.

Abstract

Objectives: To compare the accuracy of intraocular lens (IOL) calculation formulas in patients undergoing phacoemulsification combined with gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) and to determine the predictive factors for refractive errors.

Materials and methods: Fifty-three eyes of 53 patients undergoing phaco-GATT were retrospectively reviewed. The preoperative and postoperative 3-month anterior segment (AS) parameters were measured by Scheimpflug camera. The mean prediction error (PE), mean absolute error (MAE) in the Sanders-Retzlaff-Kraft/theoretical (SRK/T), Barrett- Universal II, Hill-radial basis function (Hill-RBF) and Kane formulas were compared. The influence of biometric parameters on PE were analyzed by correlation analysis.

Results: Postoperatively, there was a statistically significant decrease in axial length (AL) and significant enlargement in anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (p<0.001). The mean PE using SRK/T (-0.08 diopters [D]) was more myopic than in the Barret (0.01 D) and Hill-RBF (0.01 D). The PE closest to zero was in the Kane formula (0.001 D). The Kane formula provided a lower MAE (0.30±0.28 D) than the SRK/T (0.38±0.32 D) and Barrett (0.36±0.30 D) (p<0.001). The MAE in Hill-RBF (0.32±0.28) was comparable with that in Kane (p=0.02). Preoperative AL was significantly associated with PE in all formulas except Kane. Barrett was the only formula that did not have a significant correlation between PE and postoperative ACD and ACA.

Conclusion: The Kane formula may provide higher predictability of the IOL power calculation than the SRK/T and Barrett-Universal II formulas in phaco-GATT surgery, which can cause significant changes in the AS and AL.

Keywords: Gonioscopy-assisted transluminal trabeculotomy; intraocular lens formula; phacoemulsification; refractive error.

MeSH terms

  • Cataract* / complications
  • Glaucoma, Open-Angle* / complications
  • Glaucoma, Open-Angle* / diagnosis
  • Glaucoma, Open-Angle* / surgery
  • Gonioscopy
  • Humans
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Refraction, Ocular
  • Retrospective Studies
  • Trabeculectomy*