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).
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]).
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
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
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.
Vasavada AR, Raj SM. Cataract treatment where resources are scarce. Lancet. 2005;365:550–1.
Manvikar SR, Allen D, Steel DHW. Optical biometry in combined phacovitrectomy. J Cataract Refract Surg. 2009;35:64–9.
Seider MI, Michael Lahey J, Fellenbaum PS. Cost of phacovitrectomy versus vitrectomy and sequential phacoemulsification. Retina. 2014;34:1112–5.
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.
Lee AC, Qazi MA, Pepose JS. Biometry and intraocular lens power calculation. Curr Opin Ophthalmol. 2008;19:13–7.
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.
Murray DC, Durrani OM, Good P, Benson MT, Kirkby GR. Biometry of the silicone oil-filled eye: II. Eye. 2002;16:727–30.
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.
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.
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.
Iwase T, Oveson BC, Nishi Y. Inherent possibility of refraction error for phacovitrectomy. Clin Exp Ophthalmol. 2013;41:302–3.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hotte GJ, de Bruyn DP, de Hoog J. Post-operative refractive prediction error after phacovitrectomy: a retrospective study. Ophthalmol Ther. 2018;7:83–94.
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.
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.
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.
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.
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.
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.
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.
Cataracts in adults: management. 2018. NICE Guideline [NG77] (26 October 2017), www.nice.org.uk/guidance/ng77.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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