Surgical Outcomes in Patients With Prior Refractive Surgery Who Had Cataract Surgery Using Intraoperative Wavefront Aberrometry

Tannan, Anjali

Surgical Outcomes in Patients With Prior Refractive Surgery Who Had Cataract Surgery Using Intraoperative Wavefront Aberrometry

Monday, April 28, 2014: 3:06 PM

Room 150 (Boston Convention and Exhibition Center)

Anjali Tannan, MD, Rush University Medical Center, Chicago, IL, USA

Randy J. Epstein, MD, Chicago Cornea Consultants, Ltd, Highland Park, Illinois, USA

Parag A. Majmudar, MD, Rush University Medical Center, Hoffman Estates, Illinois, USA

Charles Faron, OD, Chicago Cornea Consultants, Hoffman Estates, IL, USA

Vanee Virasch, MD, Rush University Medical Center, Chicago, IL, USA

Jonathan B. Rubenstein, MD, Rush University Medical Center, Chicago, IL, USA

Narrative Responses:

Purpose
To compare the accuracy of current intraocular lens (IOL) power formulas with intraoperative wavefront aberrometry in patients with a prior history of refractive surgery and determine post-operative visual outcomes.

Methods
A retrospective review was done on 60 eyes in 46 patients who underwent cataract extraction April 2011 to August 2013 using the ORange and then the Optiwave Refractive Analysis (ORA) wavefront aberrometer system (WaveTec Vision System, Inc). Patients had a history of refractive surgery. IOL power was calculated using conventional formulas and the ASCRS Post-Keratorefractive IOL calculator. The ORA-recommended IOL power, implanted IOL power and ORA-predicted refraction were recorded. The postoperative UCVA and manifest refraction were noted. IOL back-calculation for emmetropia was done using previously published formulas. Statistical analysis determined the accuracy of the ORA compared to other calculations.

Results
The study included 51 eyes in 40 patients. 9 eyes were excluded. Eighteen had previous RK, 33 had PRK/LASIK. Mean postoperative UCVA was 20/40. Mean post-operative spherical equivalent (SE) was -0.18D (range -3.25 to 4.5). The implanted IOL, ORA prediction, ASCRS calculator, and conventional formulas were within 0.5D of emmetropia in 58%, 49%, 41%, 25% of eyes respectively and within 1.0 D of emmetropia in 73%, 65%, 60%, 51% of eyes. The ORA was more accurate at predicting the SE for the implanted IOL in the LASIK/PRK group (mean error in SE: 0.47D in LASIK/PRK, 1.24D in RK group, p=0.014).

Conclusion
Surgeon discretion with the use of intraoperative wavefront aberrometry improves visual outcomes in patients with prior refractive surgery. However, results reflect data from both the older ORange and newer ORA systems. The ORA’s ability to predict IOL power and refractive error in LASIK/PRK patients may be better than RK patients.