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Background To evaluate the accuracy of predicted refraction using multifocal intraocular lenses ( IOLs) with power calculation based on two biometric devices and multiple IOL power calculation formulas. Design A retrospective study conducted in a private practice ophthalmology clinic. Participants Seventy-three eyes of 48 patients were evaluated. Methods Consecutive cases of eyes that had undergone successful cataract surgery with an implantation of a multifocal IOL ( SN6 AD1, Alcon Laboratories, Inc., Fort Worth, TX, USA) by a single surgeon were enrolled. Patients were meticulously screened for suitability for a multifocal IOL implantation according to our clinic guidelines. Two biometric measurement devices ( IOLMaster-500 [ Carl Zeiss Meditec AG, Jena, Germany] and Lenstar- LS900 [ Haag- Streit AG, Koeniz, Switzerland]) were used under strict validation criteria to evaluate the predicted refraction errors for the Holladay 1, SRK/ T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Olsen formulas. Main Outcome Measures Predicted refractive sphere equivalent ( RSE) errors. Results The measurements obtained from the two biometric devices were highly correlated. The standard deviation of the error in predicted RSE and the median absolute error were similar for the IOLMaster and the Lenstar devices using all formulas, ranging from 0.27 dioptres ( D) to 0.31 D and from 0.15 D to 0.21 D, respectively. A high percentage of eyes had an error in predicted RSE within ±0.5 D from target refraction, ranging from 86.3% to 93.2%. Conclusions High accuracy can be achieved in multifocal IOL power calculations by appropriate patient selection, precise biometry and appropriate IOL calculation formulas. [ABSTRACT FROM AUTHOR]

A bstract Background: To establish whether simulated keratometry values obtained by corneal mapping (videokeratography) would provide a superior refractive outcome to those obtained by Zeiss IOLMaster (partial coherence interferometry) in routine cataract surgery. Design: Prospective, non-randomized, single-surgeon study set at the The Royal United Hospital, Bath, UK, District General Hospital. Participants: Thirty-three patients undergoing routine cataract surgery in the absence of significant ocular comorbidity. Methods: Conventional biometry was recorded using the Zeiss IOLMaster. Postoperative refraction was calculated using the SRK/T formula and the most appropriate power of lens implanted. Preoperative keratometry values were also obtained using Humphrey Instruments Atlas Version A6 corneal mapping. Main Outcome Measures: Achieved refraction was compared with predicted refraction for the two methods of keratometry after the A-constants were optimized to obtain a mean arithmetic error of zero dioptres for each device. Results: The mean absolute prediction error was 0.39 dioptres (standard deviation 0.29) for IOLMaster and 0.48 dioptres (standard deviation 0.31) for corneal mapping ( P = 0.0015). Keratometry readings between the devices were highly correlated by Spearman correlation (0.97). The Bland-Altman plot demonstrated close agreement between keratometers, with a bias of 0.0079 dioptres and 95% limits of agreement of −0.48-0.49 dioptres. Conclusions: The IOLMaster was superior to Humphrey Atlas A6 corneal mapping in the prediction of postoperative refraction. This difference could not have been predicted from the keratometry readings alone. When comparing biometry devices, close agreement between readings should not be considered a substitute for actual postoperative refraction data. [ABSTRACT FROM AUTHOR]

A bstract Background: To assess the accuracy of Haigis, Holladay 1, Hoffer Q and SRK/T formulae in eyes with axial length of <22.00 mm. Design: Retrospective comparative analysis. Participants: 163 eyes of 97 patients undergoing phacoemulsification and intraocular lens (IOL) implantation. Methods: Ocular biometry was performed using IOLMaster laser interferometry. Predicted refractive outcomes before and after lens constant adjustment were compared to actual refractive outcomes. Main Outcome Measures: Mean prediction (ME) and mean absolute errors (MAE) with standard deviations (±SD). Results: Mean preoperative spherical equivalent was +5.44D ± 1.97D. Mean axial length was 21.20 mm ± 0.60 mm. Using standard IOL constants the MAE for Hoffer Q (0.62D, ±0.52D) and Holladay 1 (0.66D ± 0.52D) were significantly lower than SRK/T (MAE 0.91D ± 0.64D; P = <0.0005 and P = 0.001 respectively), but not Haigis (MAE 0.82D ± 0.83D, P = 0.071 and 0.22 respectively). MAEs for all formulae were significantly reduced by IOL constant adjustment (all P = <0.001). Following this there was no statistically significant difference in MAEs between formulae (range 0.50-0.57D, P = 0.57). Increasing MAE was significantly associated with reducing axial length and increasing IOL power for all formulae. For bilateral cases, prediction errors between eyes were significantly correlated across all formulae (all P = <0.0001) and explained 32-42% of the variance in prediction error between eyes. Conclusions: Prediction of postoperative refraction in patients with short axial lengths is challenging and at the limit of current, popular IOL formulae. There is now a clear need for prospective studies to assess latest generation IOL formulae such as Holladay 2 or Olsen in small eyes. [ABSTRACT FROM AUTHOR]

Purpose: To report the value of dual biometry in the detection of biometry errors. Methods: Study 1: retrospective study of 224 consecutive cataract operations. The intraocular lens power calculation was based on immersion biometry. Study 2: immersion biometry was compared with optical coherence biometry (OCB) in terms of axial length, anterior chamber depth, keratometry readings and the recommended lens power to achieve emmetropia. Study 3: prospective study of 61 consecutive cataract operations. Both immersion and OCB were performed, but lens power calculation was based on the latter. Results: Study 1: 115 (86%), 101 (75.4%), 90 (67.2%) and 50 (37.3%) of postoperative spherical equivalents were within ±1.5 dioptres (D), ±1.25 D, ±1 D and ±0.5 D of the target, respectively. Study 2: excellent agreement between axial length readings, anterior chamber depth readings and keratometry readings by immersion biometry and OCB was observed (reflected in a mean bias of −0.065 mm, −0.048 mm and +0.1803 D, respectively, in association with OCB). Agreement between the lens power recommended by each technique to achieve emmetropia was poor (mean bias of +1.16 D in association with OCB), but improved following appropriate modification of lens constants in the Accutome A-scan software (mean bias with OCB = −0.4 D). Study 3: 37 (92.5%) and 23 (57.5%) of operated eyes achieved a postoperative refraction within ±1 D and ±0.5 D of target, respectively. Conclusion: Systematic errors in biometry can exist, in the presence of acceptable postoperative refractive results. Dual biometry allows each biometric parameter to be scrutinized in isolation, and identify sources of error that may otherwise go undetected. [ABSTRACT FROM AUTHOR]