Journal List > J Korean Ophthalmol Soc > v.51(2) > 1008726

TOOLS
Maeng, Ryu, Chung, and Chung: Effects of Anterior Chamber Depth and Axial Length on Refractive Error after Intraocular Lens Implantation
Original Article

J Korean Ophthalmol Soc 2010;51(2):195-202.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.195

Effects of Anterior Chamber Depth and Axial Length on Refractive Error after Intraocular Lens Implantation

Hyo-Sung Maeng, MD, Eun Hye Ryu, MD, Tae-Young Chung, MD, PhD, Eui-Sang Chung, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Eui-Sang Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine #50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3565, Fax: 82-2-3410-0074, E-mail: eschung@skku.edu

Received 27 July 2009       Accepted 17 November 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the error tendency between preoperative expected refraction and postoperative manifest refraction based on anterior chamber depth (ACD) and axial length (AXL) in cataract surgery cases and to report how ACD and AXL affect determination of intraocular lens (IOL) power.

Methods

We retrospectively studied 82 eyes of 62 patients who underwent cataract surgery in our hospital between August 2008 and January 2009. Anterior chamber depth and AXL were measured using IOL Master®, and IOL power was calculated using the SRK II and SRK/T formulae. Patients were divided into three groups based on ACD and into another three based on AXL. Refractive error (RE) was analyzed one month after surgery.

Results

Though the RE of each group showed a tendency for hyperopic shifts, only those obtained with the SRK/T formula showed statistically significant differences between groups (p＜0.05). Using the SRK/T formula, we found that an increasing AXL was associated with an increased hyperopic shift. This was more pronounced in those with shallow ACD (<2.5 mm), though the difference was not statistically significant. Similarly, an increase in ACD was associated with an increased hyperopic shift, and this difference was more pronounced in those with short AXL (＜22.5 mm), and this time the difference was statistically significant.

Conclusions

As ACD and AXL significantly affect RE, both should be considered when investigating postoperative RE tendency and when determining IOL power. Postoperative RE will be greatly affected by a short AXL or a shallow ACD, and therefore these factors should be considered in IOL power determination.

Keywords: Anterior chamber depth, Axial length, Refractive error

References

1. Holladay JT, Prager TC, Ruiz RS, et al. Improving the aberrations of intraocular lens power calculations. Arch Ophthalmol. 1986; 104:539–41.
2. Mamalis N. Complications of foldable intraocular lenses requiring explanation or secondary intervention–1998 survey. J aberrations Refract Surg. 2000; 26:766–72.
3. Olsen T. Sources of error in intraocular lens power calculation. J Cataract Refract Surg. 1992; 18:125–9.
crossref
4. Hitzenberger CK. Optical measurement of the axial eye length by laser Doppler interferometry. Invest Ophthalmol Vis Sci. 1991; 32:616–24.
5. Drexler W, Findl O, Menapace R, et al. Dual beam optical aberrations tomography: signal identification for ophthalmologic aberrations. J Biomed Opt. 1998; 3:55–65.
6. Vogel A, Dick HB, Krummenauer F. Reproducibility of optical biometry using partial coherence interferometry: intraobserver and interobserver reliability. J Cataract Refract Surg. 2001; 27:1961–8.
crossref
7. Kiss B, Findl O, Menapace R, et al. Biometry of cataractous eyes using partial coherence interferometry: clinical feasibility study of a commercial prototype I. J Cataract Refract Surg. 2002; 28:224–9.
8. Lam AK, Chan R, Pang PC. The repeatability and accuracy of axial length and anterior chamber depth measurements from the IOLMaster. Ophthalmic Physiol Opt. 2001; 21:477–83.
9. Kielhorn I, Rajan MS, Tesha PM, et al. Clinical assessment of the Zeiss IOLMaster. J Cataract Refract Surg. 2003; 29:518–22.
crossref
10. Choi JH, Roh GH. The reproducibility and accuracy of biometry parameter measurement from IOL Master. J Korean Ophthalmol Soc. 2004; 45:1665–73.
11. Kim HJ, Kim HJ, Joo CK. Comparison of IOL Master, A-scan and Orbscan II for measurement of axial length and anterior chamber depth. J Korean Ophthalmol Soc. 2003; 44:1519–27.
12. Olsen T, Thim K, Corydon L. Theoretical versus SRK I and SRK II calculation of intraocular lens power. J Cataract Refract Surg. 1990; 16:217–25.
crossref
13. McEwan JR, Massengill RK, Friedel SD. Effect of keratometer and axial length measurement errors on primary implant power calculations. J Cataract Refract Surg. 1990; 16:61–70.
crossref
14. Olsen T. Prediction of the effective postoperative (intraocular lens) anterior chamber depth. J Cataract Refract Surg. 2006; 32:419–24.
crossref
15. Weissman JL, Beatty RL, Hirsch WL, Curtin HD. Enlarged anterior chamber: CT finding of a ruptured globe. AJNR Am J Neuroradiol. 1995; 16:936–8.
16. Masket S. Alcon Restor multifocal-clinical pearls, mastering aberrations IOLs, the art and science. Thorofare, NJ: Slack, Inc.;2008. p. 125–9.
17. Bogan SJ, Waring GO 3rd, Ibrahim O, et al. Classification of normal corneal topography based on computer-assisted aberrations. Arch Ophthalmol. 1990; 108:945–9.
18. Rose LT, Moshegov CN. Comparison of the Zeiss IOLMaster and applanation A-scan ultrasound: biometry for intraocular lens calculation. Clin Experiment Ophthalmol. 2003; 31:121–4.
crossref
19. Connors R 3rd, Boseman P 3rd, Olson RJ. Accuracy and aberrations of biometry using partial coherence aberrations. J Cataract Refract Surg. 2002; 28:235–8.
20. Eleftheriadis H. IOLMaster biometry: refractive results of 100 consecutive cases. Br J Ophthalmol. 2003; 87:960–3.
crossref
21. Hwang JS, Lee JH. Comparison of the IOL master and A-scan ultrasound: Results of 96 consecutive cases. J Korean Ophthalmol Soc. 2007; 48:27–32.
22. Fedorov SN, Kolinko AI. A method of calculating the optical power of the intraocular lens. Vestn Oftalmol. 1967; 80:27–31.
23. Holladay JT, Prager TC, Chandler TY, et al. A three-part system for refining intraocular lens power calculations. J Cataract Refract Surg. 1988; 14:17–24.
crossref
24. Retzlaff JA, Sanders DR, Kraff MC. Development of the SRK/T intraocular lens implant power calculation formula. J Cataract Refract Surg. 1990; 16:333–40.
crossref
25. Hoffer KJ. The Hoffer Q formula: a comparison of theoretic and regression formulas. J Cataract Refract Surg. 1993; 19:700–12.
crossref
26. Olsen T, Olesen H, Thim K, Corydon L. Prediction of aberrations anterior chamber depth with the newer IOL calculation formulas. J Cataract Refract Surg. 1992; 18:280–5.
27. Narvaez J, Zimmerman G, Stulting RD, et al. Accuracy of aberrations lens power prediction using the Hoffer Q, Holladay 1, Holladay 2, and SRK/T formulas. J Cataract Refract Surg. 2006; 32:2050–3.
28. Lim LH, Lee SY, Ang CL. Factors affecting the predictability of SRK II in patients with normal axial length undergoing phacoemulsification surgery. Singapore Med J. 2009; 50:120–5.
29. Haigis W. The Haigis formula. HJ S, editor. Intraocular lens power calculations. Thorofare, NJ: Slack;2004. chap. 5.
30. Olsen T, Olesen H, Thim K, Corydon L. Prediction of aberrations intraocular lens chamber depth. J Cataract Refract Surg. 1990; 16:587–90.
31. Olsen T, Corydon L, Gimbel H. Intraocular lens power aberrations with an improved anterior chamber depth prediction aberrations. J Cataract Refract Surg. 1995; 21:313–9.
32. Olsen T. The Olsen formula. HJ S, editor. Intraocular Lens Power Calculations. Thorofare, NJ: Slack;2004. chap. 4.
33. Sanders DR, Retzlaff JA, Kraff MC, et al. Comparison of the SRK/T formula and other theoretical and regression formulas. J Cataract Refract Surg. 1990; 16:341–6.
crossref
34. Olsen T. Calculation of intraocular lens power: a review. Acta Ophthalmol Scand. 2007; 85:472–85.
crossref
35. Yang CH, Hung PT. Intraocular lens position and anterior chamber angle changes after cataract extraction in eyes with primary angle-closure glaucoma. J Cataract Refract Surg. 1997; 23:1109–13.
crossref
36. Chang SW, Yu CY, Chen DP. Comparison of intraocular lens power calculation by the IOLMaster in phakic and eyes with hydrophobic acrylic lenses. Ophthalmology. 2009; 116:1336–42.
crossref
37. Kang SY, Hong S, Won JB, et al. Inaccuracy of intraocular lens power prediction for cataract surgery in angle-closure glaucoma. Yonsei Med J. 2009; 50:206–10.
crossref
38. Gavin EA, Hammond CJ. Intraocular lens power calculation in short eyes. Eye. 2008; 22:935–8.
crossref

Figure 1.
Relationship between refractive error, axial length and anterior chamber depth. Note that the refractive error change increases more in shallow anterior chamber group but not statistically significant.
jkos-51-195f1.tif
Figure 2.
Relationship between refractive error, anterior chamber depth and axial length. Note that the refractive error change was statistically significant in short axial length group (p=0.00).
jkos-51-195f2.tif
Figure 3.
The postoperative change of depth of anterior chamber in shallow anterior chamber eye. The intraocular lens can be implanted in a more anterior or posterior plane than pre-operatively planned in short or long axis eye respectively. a=postoperative anterior chamber depth; b=predicted value of postoperative anterior chamber depth.
jkos-51-195f3.tif
Figure 4.
Large refractive change can be caused more in short axis than in long axis eyes.
jkos-51-195f4.tif
Table 1.
Characteristics of each group according to the anterior chamber depth (ACD)
Group A* B† C‡ Total p-value*
Eyes 11 53 18 82
Sex (M/F) 2/5 17/26 4/8 23/39
Age (years) 68.4±6.7 67.6±11.7 65.4±11.7 66.0±10.9
ACD (mm) 2.23±0.23 3.06±0.48 3.82±0.39 3.08±0.53
MNE (D)
SRK-II 0.24±0.38 0.33±0.47 0.56±0.41 0.35±0.45 0.14
SRK/T 0.37±0.49 0.20±0.42 0.55±0.40 0.32±0.47 0.00
MAE (D)
SRK-II 0.35±0.28 0.46±0.33 0.64±0.38 0.47±0.34 0.28
SRK/T 0.55±0.29 0.34±0.32 0.68±0.37 0.44±0.36 0.01

* A=Group A, ACD <2.5

† B=Group B, 2.5≤ ACD <3.5

‡ C=Group C, 3.5≤ ACD; MNE=mean numeric error, MAE=mean absolute error; 1-Way ANOVA test: Group B vs Group C: p=0.00.

Table 2.
Characteristics of each group according to the axial length (AXL)
Group a* b† c‡ Total p-value*
Eyes 13 43 26 82
Sex (M/F) 4/7 12/21 7/11 23/39
Age (years) 64.4±6.2 68.2±12.7 66.1±12.7 67.1±10.9
AXL (mm) 22.04±0.35 23.34±0.46 26.09±2.04 24.01±1.92
MNE (D)
SRK-II 0.47±0.29 0.32±0.38 0.48±0.58 0.35±0.45 0.49
SRK/T 0.32±0.41 0.21±0.39 0.67±0.48 0.32±0.47 0.00
MAE (D)
SRK-II 0.49±0.25 0.41±0.28 0.56±0.43 0.47±0.34 0.56
SRK/T 0.38±0.26 0.31±0.25 0.73±0.38 0.44±0.36 0.00

* a=Group a, AXL<22.5 mm

† b=Group b, 22.5≤ AXL <24.0

‡ c=Group c, 24.0≤ AXL; MNE=mean numeric error; MAE=mean absolute error; 1-Way ANOVA test; Group a vs Group c: p=0.00; Group b vs Group c: p=0.00.

TOOLS
Similar articles