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To assess the accuracy of intraoperative wavefront aberrometry (IWA) and modern intraocular lens (IOL) formulas including Hill-Radial Basis Function Version 2.0 (Hill-RBF), Barrett True K (BTK), Holladay 1 ± W-K adjustment, SRK/T, Haigis, and surgeon’s adjustment in post-refractive surgery patients undergoing cataract surgery.
Retrospective chart review. Thirty-four post-refractive eyes underwent cataract surgery with IWA from 05/2017 – 04/2019. Twenty-five eyes had prior myopic laser vision correction (LVC), 7 had hyperopic LVC, and 2 had radial keratotomy (RK). A capsular tension ring was placed in all eyes. Accuracy among ORA predictions and the above formulas for the chosen IOL was evaluated. Mean numerical error (MNE), mean absolute error (MAE), and percentages of prediction error within 0.25D, 0.50D, 0.75D, and 1.00D were calculated. Calculations were also performed for the percent of eyes with predicted hyperopic outcomes if the ORA-suggested versus the BTK-suggested IOL power were routinely selected.
In post-myopic LVC eyes, MNE with ORA, BTK, Haigis, SRK/T, Hill-RBF, W-K adjusted Holladay 1, and surgeon’s adjustment were +0.172, -0.171, +0.212, +0.916, +0.792, +0.603, and +0.300 (F=8.49, p<0.001). MAE were 0.510, 0.503, 0.516, 1.00, 0.878, 0.668, and 0.611 (F=3.34, p<0.01), respectively. There was no difference in MNE (p=0.07) or MAE (p=0.95) between ORA-predicted and BTK in post-hoc analysis with Tukey HSD correction. If the ORA vs BTK-suggested IOL power were routinely selected, 28% and 16% of eyes would have projected hyperopic outcomes, respectively (p=0.31). In post-hyperopic LVC, MNE with ORA and BTK were -0.065 and 0.035 (p=0.83); MAE were 0.520 and 0.721 (p=0.53), respectively.
Our study suggests that in post-myopic and post-hyperopic LVC eyes undergoing cataract surgery with capsular tension rings, the accuracy of IWA and Barrett True K are comparable. BTK may yield fewer hyperopic surprises than ORA in post-myopic LVC eyes, though further studies with larger sample sizes are necessary.