Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Biometric refractive error after cataract and retina surgery: a systematic review and a benchmark proposal

Abstract

Purpose

To systematically review studies on refractive error after phacovitrectomy and phacoemulsification and to investigate factors associated with larger error.

Materials and methods

A literature search was performed using PUBMED and EMBASE until May 2020. The articles were included in the study if they reported data about refractive error as the difference in spherical equivalent between actual vs. target refraction in patients who underwent phacovitrectomy and phacoemulsification according to the type of biometry (ultrasound or optical). An inverse variance meta-analysis technique was used to pool errors; standard deviations (SDs), which are an expression of random error, were reported descriptively as median and range of the 95% coefficient of reproducibility (95% CR: 1.96 SD).

Results

Twenty-one studies (197,353 eyes) were included. The mean error obtained using optical biometry was negligible for phacoemulsification (0.04 D, 95% CI: −0.04 to 0.12; 8 studies, 587 eyes) and was consistent with larger datasets using mixed biometric methods (0.02, 95% CI −0.07 to 0.04; 5 studies, 194,522 eyes). A trend towards hyperopia was found with ultrasound biometry after phacoemulsification (+0.21 D, 0.00–0.42 D; 7 studies, 394 eyes). Mean error after phacovitrectomy was clinically insignificant with optical biometry (−0.10 D, −0.22 to 0.02;, 8 studies, 453 eyes), and) and a mild myopic shift was possible with ultrasound biometry (−0.39 D, 95% CI: −0.68 to −0.09 D; 6 studies, 529 eyes). The 95% CR was greater and more variable with ultrasound biometry in patients who underwent phacovitrectomy (median 1.75 D, range 0.47–2.5) while it was consistent and lower with optical biometry in patients who underwent phacoemulsification (median 0.96 D, range 0.60–1.2]).

Conclusions

Phacovitrectomy causes a mild myopic shift compared to phacoemulsification, which is clinically relevant only with ultrasound biometry. Furthermore, our review provides estimates of fixed and random error for postoperative vs. target spherical equivalent as a continuous variable, that is easy to use as benchmark for quality assurance.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Fig. 1: PRISMA flow diagram updated in May 2020.
Fig. 2: Meta-analysis of the mean differences between predicted and target refraction.
Fig. 3: The results of the individual studies including the mean error (or fixed bias) with 95% Bland–Altman limits of agreement, which express the maximum error obtained in the study, are presented.

References

  1. Gillies M, Brian G, La Nauze J, Le Mesurier R, Moran D, Taylor H, et al. Modern surgery for global cataract blindness: preliminary considerations. Arch Ophthalmol. 1998;116:90–92.

    CAS  Article  Google Scholar 

  2. Vasavada AR, Raj SM. Cataract treatment where resources are scarce. Lancet. 2005;365:550–1.

    Article  Google Scholar 

  3. Manvikar SR, Allen D, Steel DHW. Optical biometry in combined phacovitrectomy. J Cataract Refract Surg. 2009;35:64–9.

    Article  Google Scholar 

  4. Seider MI, Michael Lahey J, Fellenbaum PS. Cost of phacovitrectomy versus vitrectomy and sequential phacoemulsification. Retina. 2014;34:1112–5.

    Article  Google Scholar 

  5. Kovacs I, Ferencz M, Nemes J, Somfai G, Salacz G, Recsan Z. Intraocular lens power calculation for combined cataract surgery, vitrectomy and peeling of epiretinal membranes for macular oedema. Acta Ophthalmol Scand. 2007;85:88–91.

    Article  Google Scholar 

  6. Lee AC, Qazi MA, Pepose JS. Biometry and intraocular lens power calculation. Curr Opin Ophthalmol. 2008;19:13–7.

    Article  Google Scholar 

  7. Zhang Z, Miao Y, Fang X, Luo Q, Wang Y. Accuracy of the Haigis and SRK/T formulas in eyes longer than 29.0 mm and the influence of central corneal keratometry reading. Curr Eye Res. 2018;43:1316–21. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050525705&doi=10.1080%2F02713683.2018.1488265&partnerID=40&md5=1727a52ff90553e55cf54d1a1cfc2e0b.

    Article  Google Scholar 

  8. Murray DC, Durrani OM, Good P, Benson MT, Kirkby GR. Biometry of the silicone oil-filled eye: II. Eye. 2002;16:727–30.

    CAS  Article  Google Scholar 

  9. Fajgenbaum MAP, Robins J, Williamson TH. Refractive outcomes using the lenstar optical low coherence reflectometry biometer in phacovitrectomy for epiretrinal membranes and macular holes. Open J Ophthalmol. 2017;7:216–24.

    Article  Google Scholar 

  10. van der Geest LJ, Siemerink MJ, Mura M, Mourits MP, Lapid-Gortzak R. Refractive outcomes after phacovitrectomy surgery. J Cataract Refract Surg. 2016;42:840–5.

    Article  Google Scholar 

  11. Kim M, Kim HE, Lee DH, Koh HJ, Lee SC, Kim SS. Intraocular lens power estimation in combined phacoemulsification and pars Plana vitrectomy in eyes with epiretinal membranes: a case-control study. Yonsei Med J. 2015;56:805–11.

    Article  Google Scholar 

  12. Iwase T, Oveson BC, Nishi Y. Inherent possibility of refraction error for phacovitrectomy. Clin Exp Ophthalmol. 2013;41:302–3.

    PubMed  Google Scholar 

  13. Suzuki Y, Sakuraba T, Mizutani H, Matsuhashi H, Nakazawa M. Postoperative refractive error after simultaneous vitrectomy and cataract surgery. Ophthalmic Surg Lasers. 2000;31:271–5.

    CAS  Article  Google Scholar 

  14. Hamoudi H, La, Cour M. Refractive changes after vitrectomy and phacovitrectomy for macular hole and epiretinal membrane. J Cataract Refract Surg. 2013;39:942–7.

    Article  Google Scholar 

  15. Lundström M, Dickman M, Henry Y, Manning S, Rosen P, Tassignon MJ, et al. Risk factors for refractive error after cataract surgery: Analysis of 282811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery. J Cataract Refract Surg. 2018;44:447–52.

    Article  Google Scholar 

  16. Brogan K, Diaper CJM, Rotchford AP. Cataract surgery refractive outcomes: representative standards in a National Health Service setting. Br J Ophthalmol. 2019;103:539–43.

    Article  Google Scholar 

  17. Shi L, Chang JS, Suh LH, Chang S. Differences in refractive outcomes between phacoemulsification for cataract alone and combined phacoemulsification and vitrectomy for epiretinal membrane. Retina. 2018.

  18. Falkner-Radler CI, Benesch T, Binder S. Accuracy of preoperative biometry in vitrectomy combined with cataract surgery for patients with epiretinal membranes and macular holes. Results of a prospective controlled clinical trial. J. Cataract Refract. Surg. 2008;34:1754–60.

    Article  Google Scholar 

  19. Reitblat O, Levy A, Kleinmann G, Assia EI. Accuracy of intraocular lens power calculation using three optical biometry measurement devices: the OA-2000, Lenstar-LS900 and IOLMaster-500. Eye. 2018;32:1244–52.

    Article  Google Scholar 

  20. Drexler W, Findl O, Menapace R, Rainer G, Vass C, Hitzenberger CK, et al. Partial coherence interferometry: a novel approach to biometry in cataract surgery. Am J Ophthalmol. 1998;126:524–34.

    CAS  Article  Google Scholar 

  21. Fajgenbaum MAP, Robins J, Williamson TH. Refractive outcomes using the lenstar optical low coherence reflectometry biometer in phacovitrectomy for epiretrinal membranes and macular holes. Open J. Ophthalmol. 2017;7:216–24.

    Article  Google Scholar 

  22. Rahman R, Bong CX, Stephenson J. Accuracy of intraocular lens power estimation in eyes having phacovitrectomy for rhegmatogenous retinal detachment. Retina. 2014;34:1415–20.

    Article  Google Scholar 

  23. Jeoung JW, Chung H, Yu HG. Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy: results of a prospective study. J Cataract Refract Surg. 2007;33:108–14.

    Article  Google Scholar 

  24. Hotte GJ, de Bruyn DP, de Hoog J. Post-operative refractive prediction error after phacovitrectomy: a retrospective study. Ophthalmol Ther. 2018;7:83–94.

    Article  Google Scholar 

  25. Kim M, Park YS, Lee DH, Koh HJ, Lee SC, Kim SS. Comparison of surgical outcome of 23-gauge and 25-gauge microincision vitrectomy surgery for management of idiopathic epiretinal membrane in pseudophakic eyes. Retina. 2015;35:2115–20.

    Article  Google Scholar 

  26. Simon SS, Chee YE, Haddadin RI, Veldman PB, Borboli-Gerogiannis S, Brauner SC, et al. Achieving target refraction after cataract surgery. Ophthalmology. 2014;121:440–4.

    Article  Google Scholar 

  27. Abu El Einen KG, Shalaby MH, El Shiwy HT. Immersion B-guided versus contact A-mode biometry for accurate measurement of axial length and intraocular lens power calculation in siliconized eyes. Retina. 2011;31:262–5.

    Article  Google Scholar 

  28. Lamson TL, Song J, Abazari A, Weissbart SB. Refractive outcomes of phacoemulsification after pars plana vitrectomy using traditional and new intraocular lens calculation formulas. J Cataract Refract Surg. 2019;45:293–7.

    Article  Google Scholar 

  29. Aristodemou P, Sparrow JM, Kaye S. Evaluating refractive outcomes after cataract surgery. Ophthalmology. 2019;126:13–18. https://doi.org/10.1016/j.ophtha.2018.07.009.

    Article  PubMed  Google Scholar 

  30. Lu MJ, Zhong WH, Liu YX, Miao HZ, Li YC, Ji MH. Sample size for assessing agreement between two methods of measurement by Bland-Altman Method. Int. J. Biostat. 2016;12:/j/ijb.2016.12.issue-2/ijb-2015-0039/ijb-2015-0039.xml.

  31. Melles RB, Holladay JT, Chang WJ. Accuracy of intraocular lens calculation formulas. Ophthalmology. 2018;125:169–78. https://doi.org/10.1016/j.ophtha.2017.08.027.

    Article  PubMed  Google Scholar 

  32. Cataracts in adults: management. 2018. NICE Guideline [NG77] (26 October 2017), www.nice.org.uk/guidance/ng77.

Download references

Author information

Authors and Affiliations

Authors

Contributions

MA and VG designed the study, carried out data extraction, drafted and clinically reviewed the manuscript the manuscript. VG performed the statistical analysis. FC carried out data extraction and drafted manuscript. AG, SA, RS, FG drafted and critically reviewed the manuscript.

Corresponding author

Correspondence to Alba Miele.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Miele, A., Fumagalli, C., Abbruzzese, G. et al. Biometric refractive error after cataract and retina surgery: a systematic review and a benchmark proposal. Eye 35, 3049–3055 (2021). https://doi.org/10.1038/s41433-020-01381-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-020-01381-1

Search

Quick links