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. Use the video link to jump to that poster in the session.
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
Abinaya Thenappan, MD
Co-Authors
William Wiley MD, Shamik Bafna MD, Kathleen Jee MD
Purpose
Assess visual outcomes and refractive tolerance of an advanced monofocal IOL with built-in negative spherical aberration (SA) and a slightly extended depth of focus (DOF) in eyes with a history of myopic LASIK or radial keratotomy (RK) .
Methods
A retrospective observational study of 200 eyes implanted between January 2022 and July 2024 with an advanced monofocal IOL (Tecnis Eyhance) with negative SA and a slightly extended DOF. Only eyes with a history of myopic LASIK or RK were included. Exclusion criteria were eyes with limited visual potential due to conditions like amblyopia or other ocular pathologies, as well as those with untreated visually significant posterior capsular opacification (PCO). Outcome measures include manifest refraction, uncorrected and best-corrected visual acuity at postoperative day 1 (POD1), week 1 (POW1), month 1 (POM1), and month 3 (POM3), refractive accuracy (% � 0.5D of target), and enhancement rates.
Results
The mean uncorrected distance visual acuity (UDVA) was 0.15�0.20 logMAR at POM1 and 0.17�0.20 logMAR at POM3, with 77% of eyes achieving UDVA of 20/30 or better at POM1 and 3. The mean corrected distance visual acuity (CDVA) was 0.03�0.09 logMAR at POM1 and 0.05�0.06 logMAR at POM3, with 96.1% and 93.3% of eyes achieving CDVA of 20/30 or better. The mean postoperative manifest refraction spherical equivalent (MRSE) was -0.43�0.73 D at POM1 and -0.58�0.45 D at POM3. A total of 61% and 50% of eyes achieved MRSE within 0.50 D at POM1 and 3, respectively. The enhancement rate was 1.2%.
Conclusion
Implantation of Tecnis Eyhance in post-refractive surgery eyes yielded good visual and refractive outcomes. The rate of enhancements following surgery was low and good distance vision was achieved even though a large proportion of eyes were not within 0.5 D MRSE.
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
Danmin Cao, PhD, MD
Purpose
To evaluate the accuracy of the total keratometry combined with Cooke-Modified Axial Length Formulas in eyes with extremely long axial lengths (AL? 28mm) following myopic laser vision correction (LVC).
Methods
A total of 101 eyes were included, with 50 eyes in Group 1(AL < 28 mm) and 51 eyes in Group 2 (AL ? 28 mm). Refractive prediction errors (RPEs) were compared among seven post-LVC formulas: Haigis-TK, Haigis-TKCMAL (incorporating Cooke-modified AL, CMAL), LISA, Barrett True-K TK, EVO TK, Haigis-L and Shammas no history. Pearson correlation analysis was employed to evaluate the influence of AL and other biometric parameters on RPEs.
Results
In Group 1, Barrett True-K TK demonstrated the best accuracy with the lowest RMSAE (0.56 D) and the highest percentage of eyes with RPEs within �1.00 D (96.00%). However, in Group 2, Haigis-TKCMAL showed superior performance with the lowest RMSAE (0.48 D), MAE (0.35 D), and MedAE (0.27 D), as well as the highest percentage of eyes with RPEs within �0.50 D (74.51%) and �1.00 D (94.12%). Nevertheless, there was a slight undercorrection and a mild hyperopic shift observed after surgery. A significant negative correlation between AL and RPE was found for most formulas. Apart from the Haigis-L formula, the longer the axial length, the higher the postoperative myopic drift for the other formulas
Conclusion
Most formulas exhibit myopic drift, while the Haigis-TKCMAL formula presents a mild hyperopic drift for post-myopia refractive IOL calculation in eyes with extremely long axial lengths(AL ? 28 mm). Using the Haigis-TKCMAL formula and the Barrett formula to calculate the average degree is an accurate choice.
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="" the="" latter="" formula="" having="" a="" mne="" (-0.22="" d)="" significantly="" different="" from="" 0=""><0.05). no="" difference="" in="" rpe="" sds="" and="" refractive="" accuracy="" was="" reported="" among="" these="" formulas="" in="" m-lasik="">
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.
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