Preoperative Clinical Profile and Coexisting Ocular Disease Among Phacoemulsification Candidates at Utama Eye Clinic Gresik

Aim: The primary outcome is to assess visual outcomes following cataract surgery in axial myopic patients. The secondary outcome assessed is perioperative complications rate due to high axial length. Materials and Methods: Type of study: It was a retrospective, noncomparative case series study. Inclusion criteria: Patients with axial length more than or equal to 25 mm with visually significant cataract in one or both eyes were recruited for the study. Patients with pathological myopia were also included – visual recovery was assessed in conjunction with the preoperative best-corrected visual acuity. Exclusion criteria: Myopic patients with cataract with other causes of visual loss such as macular scar, diabetic retinopathy, age-related macular degeneration, disc edema, vein occlusion, and epiretinal membrane were excluded from the study. Sample Size: The sample size of the study was 32 patients (49 eyes). All patients recruited for the study underwent complete anterior segment examination in slit lamp with due importance to the type of cataract, visual acuity examination, and refraction to assess preoperative best-corrected visual acuity and posterior segment examination with 90 D lens. If the posterior segment was not visualized, B-scan was done. Blood investigations include complete blood count, random blood sugar, HIV, hepatitis B virus surface antigen, and urine albumin/sugar. With the test results and electrocardiogram, anesthetist fitness was obtained. Duct patency and intraocular pressure (IOP) were measured. Automated keratometry and axial length were measured by immersion technique done to calculate intraocular lens (IOL) power. IOL power calculation was performed using the SRK/T which was found to be reliable in axial lengths above 25 mm. Anterior chamber depth and lens thickness were also measured. All patients underwent phacoemulsification with IOL implantation by experienced single surgeon. The main outcomes measured were visual acuity after cataract surgery with implantation of zero or negative or very low IOL power at 1-month postoperative period and intraoperative and postoperative complications. The method of surgery did not influence the visual outcome. Results: The mean age of the patient operated on was about 61.9 years. In our study, the most common type of cataract was nuclear cataract (63.2%). Only 4.1% had previous refractive surgery. About 65.3% had 6/6 vision postcataract surgery with axial myopia. About 51.1% of axial myopic patients' fundus changes before cataract surgery which could be one of the causes for poor visual acuity. No significant perioperative complications were observed. Conclusion: Good postoperative outcomes following cataract surgery were observed in patients with cataract and high myopia. Refractive error is a potential complication as the hyperopic error appears to increase with axial length, especially in patients receiving negative power lens. If a sulcus IOL is inserted, it is more likely to be unstable or decenter because of the larger sulcus size. The need for Nd: YAG capsulotomy for posterior capsular opacity was found to be more common in myopes with high axial length compared to the general population. IOP reduction is slower and unstable for the first 30 days of postcataract surgery in highly myopic eyes.

Background: Humanitarian missions and mobile camp surgeries have pivotal roles in cataract surgery in areas with limited resources. Ocular biometry is an important preoperative evaluation tool for cataract surgery candidates. Herein, we report the distributions of ocular biometric values among cataract surgery candidates in camp settings in southern Nigeria. Methods: In this cross-sectional study, we retrieved data from consecutive patients scheduled for cataract surgery. All patients underwent a full ophthalmic examination using a slit-lamp biomicroscope. Age, sex, and preoperative biometric values, including anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and axial length (AL), together with intraocular lens (IOL) power, were documented. Biometric values were obtained using A-mode ultrasonography. Results: Records of 567 patients with a mean (standard deviation) age of 66.0 (13.4) years revealed a male-to-female sex ratio of 1:1.24. Most participants were in the 66–70-year age group. Mean IOL power was significantly different between males and females (P < 0.001). However, the biometric values were comparable between sexes (all P > 0.05). There were significant differences in the mean IOL power (P < 0.001) and ACD (P < 0.05) between the age groups, indicating a decrease in ACD with age. However, the other biometric parameters were comparable between the age groups (all P > 0.05). ACD had a significant weak negative correlation with LT (r = - 0.16; P < 0.001) and IOL power (r = - 0.22; P < 0.001) and a positive correlation with AL (r = + 0.24; P < 0.001). LT had a significant weak negative correlation with VCD (r = - 0.16; P < 0.001) and a positive correlation with AL (r = + 0.09; P < 0.05). VCD had significant moderate positive and negative correlations with AL (r = + 0.39; P < 0.001) and IOL power (r = - 0.34; P < 0.001), respectively. AL had a significant strong negative correlation with IOL power (r = - 0.78; P < 0.001). Conclusions: This study presents the mean distributions of ocular biometric parameters among cataract surgery candidates in camp settings in southern Nigeria. Age and sex were important determinants of IOL power and should be considered when planning eye camp supplies. AL had a strong inverse correlation with IOL power. Further multicenter national studies are required to verify these preliminary findings.

This study aimed to demonstrate how the level of accuracy in intraocular lens (IOL) power calculation can be improved with optical biometry using partial optical coherence interferometry (PCI) (Zeiss IOLMaster) and current anterior chamber depth (ACD) prediction algorithms. Intraocular lens power in 461 consecutive cataract operations was calculated using both PCI and ultrasound and the accuracy of the results of each technique were compared. To illustrate the importance of ACD prediction per se, predictions were calculated using both a recently published 5-variable method and the Haigis 2-variable method and the results compared. All calculations were optimized in retrospect to account for systematic errors, including IOL constants and other off-set errors. The average absolute IOL prediction error (observed minus expected refraction) was 0.65 dioptres with ultrasound and 0.43 D with PCI using the 5-variable ACD prediction method (p < 0.00001). The number of predictions within +/- 0.5 D, +/- 1.0 D and +/- 2.0 D of the expected outcome was 62.5%, 92.4% and 99.9% with PCI, compared with 45.5%, 77.3% and 98.4% with ultrasound, respectively (p < 0.00001). The 2-variable ACD method resulted in an average error in PCI predictions of 0.46 D, which was significantly higher than the error in the 5-variable method (p < 0.001). The accuracy of IOL power calculation can be significantly improved using calibrated axial length readings obtained with PCI and modern IOL power calculation formulas incorporating the latest generation ACD prediction algorithms.

PurposeTo investigate the effect of the optional biometric parameters lens thickness (LT) and center corneal thickness (CCT) in the Kane formula on intraocular lens (IOL) power calculation.MethodsA cross-sectional study included consecutive cataract patients who received uncomplicated cataract surgery with IOL implantation from May to September 2022 were enrolled. The ocular biometric parameters were obtained using IOLMaster 700 and then inputted into online Kane formula calculator. The IOL power was calculated for targeting emmetropia and compared between groups: not omitting (NO) group, omitting LT and CCT (OLC) group, omitting LT (OL) group and omitting CCT (OC) group. Further, according to the axial length (AL), anterior chamber depth (ACD), and mean keratometry (Km), the eyes were divided into three subgroups, respectively.Results1005 eyes of 1005 consecutive patients were included. There was no significant difference in IOL power between NO group and OC group (P = 0.064), and the median absolute difference (MedAD) was 0.05D. The IOL power in NO group showed significant differences from OLC group and OL group respectively (P < 0.001), and both MedAD values were 0.18D. Among AL subgroups, MedAD ranged from 0.06D to 0.35D in short eyes. Among ACD subgroups, the above values ranged from 0.06D to 0.23D in shallow ACD subgroup. Among Km subgroups, these values ranged from 0.05D to 0.31D in steep Km subgroup.ConclusionThe optional biometric parameter CCT has no effect on the calculation results of the Kane formula, whereas the parameter LT has a great influence on the Kane formula results for the IOL power calculation in cataract patients with short AL, shallow ACD and steep Km.

To investigate the effect of the optional biometric parameters lens thickness (LT) and center corneal thickness (CCT) in the Kane formula on intraocular lens (IOL) power calculation. A cross-sectional study included consecutive cataract patients who received uncomplicated cataract surgery with IOL implantation from May to September 2022 were enrolled. The ocular biometric parameters were obtained using IOLMaster 700 and then inputted into online Kane formula calculator. The IOL power was calculated for targeting emmetropia and compared between groups: not omitting (NO) group, omitting LT and CCT (OLC) group, omitting LT (OL) group and omitting CCT (OC) group. Further, according to the axial length (AL), anterior chamber depth (ACD), and mean keratometry (Km), the eyes were divided into three subgroups, respectively. 1005 eyes of 1005 consecutive patients were included. There was no significant difference in IOL power between NO group and OC group (P = 0.064), and the median absolute difference (MedAD) was 0.05D. The IOL power in NO group showed significant differences from OLC group and OL group respectively (P < 0.001), and both MedAD values were 0.18D. Among AL subgroups, MedAD ranged from 0.06D to 0.35D in short eyes. Among ACD subgroups, the above values ranged from 0.06D to 0.23D in shallow ACD subgroup. Among Km subgroups, these values ranged from 0.05D to 0.31D in steep Km subgroup. The optional biometric parameter CCT has no effect on the calculation results of the Kane formula, whereas the parameter LT has a great influence on the Kane formula results for the IOL power calculation in cataract patients with short AL, shallow ACD and steep Km.

PurposeThe present study sought to evaluate the effects of pupil dilation on ocular parameter measurements and intraocular lens (IOL) power calculation using IOLMaster in highly myopic cataract patients.Materials and methodsA total of 233 eyes were included in this prospective study and assigned to four groups based on range of axial length (AL) as follows: group A:26–28 mm, group B:28–30 mm, group C:30–32 mm, and group D:32–36 mm. Flattest and steepest keratometry (K1 and K2), AL, anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WtW) were determined using IOLMaster before and after administration of topical tropicamide. The corresponding IOL powers were calculated using Sanders–Retzlaff–Kraff/theoretical (SRK/T), Haigis, and Barrett Universal II formulas.ResultsVariations in AL, K1 and K2 following dilation were not significant (P > 0.05 in all groups). The results showed that ACD increased significantly after dilation (P = 0.000 in all groups), whereas LT decreased significantly after dilation (P = 0.000, 0.000, 0.001, and 0.003). Post-dilation WtW increased significantly in Group A, B, and C (P = 0.001, 0.001, and 0.025) but not in Group D. When IOL power was calculated as a discrete variable, significant differences were observed between pre- and post-dilation IOL power.ConclusionPupil dilation in cataract eyes with high myopia does not cause significant changes in AL and K. However, it significantly increases ACD as well as WtW values and significantly decreases the LT value. Surgeons should evaluate the effect of pupil dilation on IOL power prediction as the present findings show extreme cases. Notably, Barrett Universal II formula had the best concordance between different pupil conditions in long eyes.

This research aimed to investigate the potential differences in the parameters, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), flat keratometry (Kf), steep keratometry (Ks), mean keratometry (Km), astigmatism, white-to-white (WTW) distance, acquired rate, and intraocular lens (IOL) power, between the two swept-source optical coherence tomography (SS-OCT) biometers, the ANTERION (biometer A) and IOLMaster 700 (biometer B). In a prospective observational comparative case series study, we enrolled 198 eyes undergoing cataract surgery. The AL, CCT, ACD, LT, Kf, Ks, Km, astigmatism, WTW, acquired rate, and IOL power were assessed. McNemar tests compared the acquired rate, and the paired sample t-test compared the quantitative measurement results between the groups. Nineteen eyes were excluded owing to missing AL data for either biometer. Finally, data from 179 eyes were analyzed. Between the two devices, no significant difference was found in AL, astigmatism magnitude, J0, and J45, while significant differences existed in CCT, ACD, LT, Kf, Ks, Km, WTW, astigmatism axis, and IOL power; no statistical significance was found in the AL acquired rate (biometer A, 90.9% and biometer B, 93.9%). Approximately 65.4% of eyes demonstrated ≥0.5-D difference in IOL power between the two biometers. In conclusion, the two biometers showed significant differences in all measurements (CCT, ACD, LT, K, WTW, astigmatism axis, and IOL power), except for AL.

Introduction: Cataract remains the leading cause of blindness in Indonesia, accounting for over 80% of severe visual impairment. Given the substantial burden in East Java, this study aimed to characterize cataract patients' demographic and ocular biometric profiles at KMU Eye Clinic Lamongan. Methods: A cross-sectional descriptive study reviewed the medical records of patients who underwent cataract surgery in April 2024. Inclusion criteria included patients scheduled for surgery via phacoemulsification or Small Incision Cataract Surgery (SICS). Data collected included demographics, systemic comorbidities, and ocular biometric parameters: intraocular pressure (IOP), anterior chamber depth (ACD), lens thickness (LT), intraocular lens (IOL) power, and surgery duration. Result: A total of 192 patients were analyzed. The mean age was 63.6±8.3 years, with 50% aged 60-69 years. Hypertension (66.7%) and diabetes (17.2%) were the most common systemic comorbidities. Severe visual impairment (≤3/60) was observed in 59.9% of cases. Phacoemulsification was performed in 97% of surgeries. Mean values for ocular biometrics were: IOP 15.1±3.6 mmHg, ACD 3.2±0.4 mm, LT 4.3±0.7 mm, IOL power 19.8±4.1 D, and surgery time 9.5±3.5 minutes. Conclusion: Most cataract patients at KMU Eye Clinic Lamongan were elderly with significant systemic comorbidities and severe visual impairment. Phacoemulsification was the preferred surgical technique. Ocular biometric analysis provided essential information for preoperative planning and optimizing cataract management.

PurposeTo investigate the effect of pupil dilation on ocular biometric parameters and intraocular lens (IOL) power calculation in schoolchildren using the Lenstar LS 900.MethodsOne hundred forty eyes of 140 healthy schoolchildren were included in the analysis. Axial length (AL), central corneal thickness (CCT), aqueous depth (AD), anterior chamber depth (ACD), lens thickness (LT), flat keratometry (K), steep K, astigmatism, white-to-white (WTW), and iris/pupil barycenter distance were measured, before and after pupil dilation. Anterior segment length (ASL) was defined as the sum of ACD and LT, and lens position (LP) was defined as ACD plus half of the LT. The relative lens position (RLP) was defined as LP divided by AL. IOL power was calculated using the eight formulas (Hill-RBF, Barrett, Haigis, Hoffer Q, Holladay, Olsen, SRK II, and SRK/T) integrated in the Lenstar LS 900. Parameters before and after pupil dilation were compared.ResultsAL, AD, ACD, LT, ASL, LP, RLP, flat K, iris barycenter distance, pupil barycenter distance, and PD differed significantly after pupil dilation (P < 0.001 in all cases), as compared to before dilation. The Olsen formula demonstrated significant differences in the magnitude of astigmatism (P = 0.010) and IOL power (P = 0.003) after pupil dilation. Using the different formulas, 23.6–40.7% of participants had IOL power changes of more than 0.50 diopters, while 0.7–1.4% had IOL changes of more than 1.0 diopter after pupil dilation.ConclusionsDilated and undilated pupil size affected the Lenstar LS 900 measurement of some ocular biometric parameters, and pupil dilation led to IOL power changes exceeding 0.50 diopters with a high percentage (from 23.6% to 40.7%) in schoolchildren, which should be noticed in clinical practice.

The aim of this study was to investigate the influence of ocular biometry parameters on the predictive accuracy of 10 intraocular lens (IOL) power formulas in patients with high myopia (HM). We analyzed 202 eyes of 202 patients. The ocular biometry was determined preoperatively using an IOLMaster700. The associations between the biometry parameters and the prediction error (PE) 1month postoperatively were assessed. HM was defined as an axial length exceeding 26.50mm. In patients with HM (n = 108), the K6, Emmetropia Verifying Optical (EVO), Olsen, and Barrett UniversalII (BUII) formulas had the lowest absolute PEs among the 10 formulas. The ocular biometry parameters were not associated with the PE of K6, EVO, Olsen, or BUII. A longer axial length in HM eyes was associated with myopic outcomes by Kane, Hoffer QST, and VRF and hyperopic outcomes by Holladay2 and T2. Steeper keratometry, a deeper anterior chamber, and a thicker lens were associated with a hyperopic shift in HM eyes when using VRF, Kane, and Hoffer QST, respectively. In patients without HM (n = 94), there was no difference between the formulas in absolute PE. The significant associations between the biometry parameters and PE in patients with HM were not present in patients without HM. K6, EVO, Olsen, and BUII displayed high accuracy in HM eyes and were not influenced by preoperative biometry parameters. For the remaining formulas, the preoperative keratometry, anterior chamber depth, lens thickness, and axial length were possible error sources underlying an inaccurate IOL power prediction in patients with HM.

Accurate ocular biometric measurements are essential for optimal intraocular lens (IOL) power calculation during cataract surgery. Axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and vitreous chamber depth (VCD) are critical parameters that may vary with age, sex, and ethnicity. Most IOL power formulas are based on biometric data from non-African populations, limiting their precision when applied locally. This study aimed to determine the mean ocular biometric values of pre-operative cataract patients at Marist Cottage Hospital, Uturu, Nigeria, to establish region-specific reference values and assess correlations with age and sex. A prospective cross-sectional study was conducted from May 2023 to April 2024 involving 1,190 pre-operative cataract patients. Biometric parameters including AL, ACD, LT, and VCD were measured using a Sonomed PacScan 300A+ A-scan ultrasound. Demographic data were also recorded. Pearson and Spearman correlation analyses were used to assess linear and monotonic relationships between axial length and other parameters, including age. The mean AL was 22.54 ± 1.32 mm, ACD 2.63 ± 0.49 mm, LT 3.99 ± 0.67 mm, and VCD 15.99 ± 1.15 mm. Males had longer axial lengths (23.04 mm) than females (22.83 mm), though not statistically significant (p = 0.386). Pearson correlation revealed significant positive relationships between AL and ACD (r = 0.4931), LT (r = 0.3717), and VCD (r = 0.5578), all p &lt; 0.05. Spearman correlation showed similar monotonic associations. Notably, axial length had a statistically significant negative monotonic correlation with age (Spearman’s r = –0.3680, p &lt; 0.001), indicating a consistent decline in AL with increasing age. The study provides essential biometric data for cataract surgery in Southeastern Nigeria. The negative correlation between axial length and age underscores the need for age-specific considerations in IOL power calculations. This local dataset enhances accuracy in surgical outcomes and supports evidence-based ophthalmic care in the region.

BackgroundDespite the surge in the number of cataract surgeries, there is limited information available regarding the influence of pupil dilation on predicted postoperative refraction and its comparison with recommended various intraocular lens power calculated using the different parameters. We used three different IOL power calculation formulas: Barrett Universal II (Barrett) (5-variable formula), Haigis (3-variable formula), and SRK/T (2-variable formula), in order to investigate the potential effect of pupil dilation on the predicted postoperative refraction (PPR) and recommended intraocular lens (IOL) power calculation.MethodsThis retrospective study included 150 eyes. All variables were measured and calculated using a ZEISS IOL Master 700. The following variables were measured before and after dilation: anterior chamber depth (ACD), lens thickness (LT), white-to-white (WTW). PPR and recommended IOL power were calculated by Barrett, Haigis, and SRK/T IOL calculation formulas. The change in each variable before and after dilation, and the correlations between all changes were analyzed using the Wilcoxon signed-rank test and the Spearman’s rank-order correlation test, respectively.ResultsThe mean absolute change (MAC) in PPR before and after dilation was found to be highest in the Barrett formula. Significant differences were found between each MAC (P < 0.0001). Significant changes were observed before and after dilation in ACD and LT (P < 0.0001), but not in WTW. Using the Barrett and Haigis formulas, there was a significant positive correlation between the change in PPR and change in ACD (P < 0.0001), and a negative correlation between change in PPR and change in LT (P < 0.0001). The correlations were strongest with the Barret formula followed by the Haigis, particularly in terms of LT. Changes in PPR determined by the Barrett formula also demonstrated a significant positive correlation with changes in WTW (P = 0.022). The recommended IOL power determined using Barrett and Haigis changed before and after dilation in 23.3 and 19.3% cases respectively, while SRK/T showed no change.ConclusionsIn terms of PPR and recommended IOL power, pupil dilation influenced mostly the Barrett formula. Given the stronger correlation between the changes in PPR when using Barrett and the changes in ACD, LT, and WTW, changes in ACD, LT, and WTW significantly affect how dilation influences the Barrett formula. Determining how dilation influences each formula and other variables is key to improving the accuracy of IOL calculations.

Determinants of Anterior Chamber Depth: The Singapore Chinese Eye Study

Purpose To investigate the possible effect of an implantable collamer lens (ICL) on ocular biometrics and intraocular lens (IOL) power calculation. Methods Ocular measurements were taken preoperatively and at the two-month follow-up using IOLMaster 700 and Sirius in 85 eyes (43 patients) who had previously undergone ICL surgery. IOL power was calculated using either IOLMaster 700 (Barrett Universal II formula) or Sirius (ray-tracing). All data were compared using the paired t-test. Results The difference between preoperative and postoperative anterior chamber depth (ACD), lens thickness (LT), and keratometry on the steep axis (K2) measured by IOLMaster 700 was statistically significant (p < 0.001). In 11 of 85 eyes, IOLMaster misjudged the anterior surface of the ICL as that of the lens, leading to an error in ACD and LT. There were no significant differences between preoperative and postoperative axial length (AL) (p = 0.223), white to white (WTW) (p = 0.100), keratometry on flat axis (K1) (p = 0.117), or central corneal thickness (CCT) (p = 0.648), measured using IOLMaster. The difference in IOL power calculated using the Barrett II formula was significant (p = 0.013). Regression analysis showed that AL and K had the greatest influence on IOL calculation (p < 0.001), and ACD and LT had less influence (p = 0.002, p = 0.218, respectively). K1 and K2 were modified to exclude the influence of K2, and modified IOLs showed no difference between pre and postoperation (p = 0.372). Preoperative and postoperative ACD measured using Sirius were significantly different (p < 0.001); however, the IOL power calculated using ray-tracing technology showed no significant differences (p > 0.05). Conclusions The ocular biometric apparatus may misjudge the anterior surface of the lens, resulting in measurement errors of ACD and LT, which has little effect on the calculation of IOL power when using IOLMaster 700 (Barrett Universal II formula) and Sirius (ray-tracing).

To compare the anterior segment parameters of patients with pseudoexfoliation syndrome, patients with pseudoexfoliation glaucoma, and normal subjects. This prospective, controlled, comparative study included 150 eyes of 150 patients. The patients were divided into the pseudoexfoliation syndrome group, the pseudoexfoliation glaucoma group, and the control group (50 patients in each group). Axial length, central corneal thickness, aqueous depth, anterior chamber depth, lens thickness, K1 and K2 keratometry values, and white to white distance measurements were obtained by optical biometry and compared between the groups. The mean ages of the pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and control patients were 62.18 ± 6.21, 61.80 ± 6.62, and 59.40 ± 6.89 years, respectively. There were no statistically significant differences between the groups in mean age or sex ratio (p>0.05). Mean central corneal thickness was statistically significantly greater, mean aqueous depth and anterior chamber depth were statistically significantly greater, and mean lens thickness was statistically significantly less in the control group than in the pseudoexfoliation syndrome and pseudoexfoliation glaucoma groups (p<0.05). Pairwise comparisons of the pseudoexfoliation syndrome group and the pseudoexfoliation glaucoma group revealed that there were no significant differences between these two groups in central corneal thickness, aqueous depth, anterior chamber depth, and lens thickness (p>0.017). Patients with pseudoexfoliation glaucoma and pseudoexfoliation syndrome had greater lens thickness, shallower aqueous depth and anterior chamber depth, and less central corneal thickness than normal subjects. None of the anterior segment parameters differed between patients with pseudoexfoliation syndrome and patients with pseudoexfoliation glaucoma.