The effects of peripheral anterior synechiae on refractive outcomes after cataract surgery in eyes with primary angle-closure disease

Comparison of intraocular lens power calculation formulas in patients with a history of acute primary angle-closure attack

BACKGROUND

To compare the accuracy of nine intraocular lens (IOL) power calculation formulas, including three traditional formulas (SRK/T, Haigis, and Hoffer Q) and six new-generation formulas (Barrett Universal II [BUII], Hill-Radial Basis Function [RBF] 3.0, Kane, Emmetropia verifying optical [EVO], Ladas Super, and Pearl-DGS) in patients who underwent cataract surgery after acute primary angle closure (APAC).

METHODS

In this retrospective cross-sectional study, 44 eyes of 44 patients (APAC) and 60 eyes of 60 patients (control) were included. We compared the mean absolute error, median absolute error (MedAE), and prediction error after surgery. Subgroup analyses were performed on whether axial length (AL) or preoperative laser peripheral iridotomy affected the postoperative refractive outcomes.

RESULTS

In the APAC group, all formulas showed higher MedAE and more myopic shift than the control group (all P < 0.05). In APAC eyes with AL ≥ 22 mm, there were no differences in MedAEs according to the IOL formulas; however, in APAC eyes with AL < 22 mm, Haigis (0.49 D) showed lower MedAE than SRK/T (0.82 D) (P = 0.036) and Hill-RBF 3.0 (0.54 D) showed lower MedAE than SRK/T (0.82 D), Hoffer Q (0.75 D) or Kane (0.83 D) (P = 0.045, 0.036 and 0.027, respectively). Pearl-DGS (0.63 D) showed lower MedAE than Hoffer Q (0.75 D) and Kane (0.83 D) (P = 0.045 and 0.036, respectively). Haigis and Hill-RBF 3.0 showed the highest percentage (46.7%) of eyes with PE within ± 0.5 D in APAC eyes with AL < 22 mm. Iridectomized eyes did not show superior precision than the non-iridotomized eyes in the APAC group.

CONCLUSIONS

Refractive errors in the APAC group were more myopic than those in the control group. Haigis and Hill-RBF 3.0 showed high precision in the eyes with AL < 22 mm in the APAC group.

A systemic review and network meta-analysis of accuracy of intraocular lens power calculation formulas in primary angle-closure conditions

BACKGROUND

For primary angle-closure and angle-closure glaucoma, the fact that refractive error sometimes deviates from predictions after intraocular lens (IOL) implantation is familiar to cataract surgeons. Since controversy remains in the accuracy of IOL power calculation formulas, both traditional and network meta-analysis on formula accuracy were conducted in patients with primary angle-closure conditions.

METHODS

A comprehensive literature search was conducted through Aug 2022, focusing on studies on intraocular lens power calculation in primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). A systemic review and network meta-analysis was performed. Quality of studies were assessed. Primary outcomes were the mean absolute errors (MAE) and the percentages of eyes with a prediction error within ±0.50 diopiters (D) or ±1.00 D (% ±0.50/1.00 D) by different formulas.

RESULTS

Six retrospective studies involving 419 eyes and 8 formulas (Barrett Universal II, Kane, SRK/T, Hoffer Q, Haigis, Holladay I, RBF 3.0 and LSF) were included. SRK/T was used as a reference as it had been investigated in all the studies included. Direct comparison showed that none of the involved formula outperformed or was defeated by SRK/T significantly in terms of either MAE or % ±0.50/1.00 D (all P>0.05). Network comparison and ranking possibilities disclosed BUII, Kane, RBF 3.0 with statistically insignificant advantage. No significant publication bias was detected by network funnel plot.

CONCLUSIONS

No absolute advantage was disclosed among the formulas involved in this study for PAC/PACG eyes. Further carefully designed studies are warranted to evaluate IOL calculation formulae in this target population.

TRAIL REGISTRATION

Registration: PROSEPRO ID: CRD42022326541.