Determine a Proper Axial Length by Ultrasonic Biometry in Opaque Hydrophilic Acrylic Intraocular Lens

Sang Hyuk Kim; Si Hwan Choi

doi:10.3341/jkos.2008.49.9.1453

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Kim and Choi: Determine a Proper Axial Length by Ultrasonic Biometry in Opaque Hydrophilic Acrylic Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2008;49(9):1453-1460.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1453

Determine a Proper Axial Length by Ultrasonic Biometry in Opaque Hydrophilic Acrylic Intraocular Lens

Sang Hyuk Kim, M.D., Si Hwan Choi, M.D.

Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea

Address reprint requests to Si Hwan Choi, M.D. Department of ophthalmology, Chungnam National University Hospital #640 Daesa-dong, Jung-gu, Daejeon 301-846, Korea Tel: 82-42-280-7604, Fax: 82-42-255-3745, E-mail: shchoi@cnu.ac.kr

Received 14 May 2008 Accepted 29 January 2008

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 accuracy of measuring ultrasonic axial lengths using A-scan (Ocuscan^®, Alcon, USA) on opaque intraocular lenses after hydrophilic lens (ACRL-160^®, Ophthalmed, USA) implantation.

Methods

We measured axial length through ultrasonic biometry prior to intraocular lens exchange. Twelve eyes of 14 patients who had intraocular lens opacity following hydrophilic acryl lens implantation were examined in a clinical study. We compared pre-cataract operative axial lengths to pre-IOL exchange axial lengths. The pre-IOL exchange axial lengths were measured in aphakic and pseudophakic modes. In the pseudophakic mode, the ultrasound velocity through an IOL was set at a rate ranging between 1,500 m/sec to 2,200 m/sec.

Results

The pre-IOL exchange axial lengths in the pseudophakic mode at the rate of 1,600 m/sec in lens velocity were the closest to pre-cataract operative values ( p=0.88).

Conclusions

When pre-cataract operative axial length is known with a hydrophilic acrylic intraocular lens, previous values may be used for IOL exchange of an opacity patient. If not, however, the closest values to pre-cataract operative axial lengths may be obtained by setting the velocity in the pseudophakic mode to a lens velocity rate of 1,600 m/sec.

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Keywords: Axial lengths, Hydrophilic acryl lens, IOL opacity, Ultrasonic Biometry

References

1. Kohnen T. The variety of foldable intraocular lens material. J Cataract Refract Surg. 1996; 22:1255–8.

2. Ursell PG, Spalton DJ, Pande MV. . Relationship between intraocular lens biomaterials and posterior capsular opacification. J Cataract Refract Surg. 1998; 24:352–60.

3. Saika S, Miyamoto T, Ohnishi Y. Histology of anterior capsule opacification with a poly HEMA/HOHEXMA hydrophilic hydrogel intraocular lens compared to poly(methyl methacrylate), silicone, and acrylic lenses. J Cataract Refract Surg. 2003; 29:1198–203.

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8. Lee DH, Seo Y, Joo CK. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients. J Cataract Refract Surg. 2002; 28:1271–5.

9. Holladay JT, Prager TC. Accurate Ultrasonic Biometry in Pseudophakia. Am J Ophthalmol. 1993; 115:536–7.

10. Lee SB, Choi SH. Ultrasonic Determination of Axial Length in Pseudophakia. J Korean Ophthalmol Soc. 2000; 41:1164–9.

11. Lee JH, Choi SH, Kim CS. The Difference in Post-operative Refractive Error between In-the-bag and Sulcus Intraocular Lens Implantation. J Korean Ophthalmol Soc. 2002; 43:2144–50.

12. Hoffer KJ. Ultrasound velocities for axial eye length measurement. J Cataract Refract Surg. 1994; 20:554–62.

13. Kim HG, Lee SH, Choi YJ. Late Postoperative Opacification of the Foldable Hydrophilic Acrylic Intraocular Lens, ACRL-160. J Korean Ophthalmol Soc. 2003; 44:315–20.

14. Lee JY, Joo KM, Kim SH. Late Opacification of Hydrophilic Acrylic Intraocular Lenses. J Korean Ophthalmol Soc. 2002; 43:2419–29.

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Figure 1.

Slit lamp photographs of opaque hydrophilic acrylic intraocular lens.

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Figure 2

. (A) Ultrasonic analyzer 5601A (Panametric, USA) measures for the measurement of ultrasonic velocity in hydrophilic acrylic lens (ACRL-C160^®, Ophthalmed, USA). (B) Result of the measurement: Ultrasonic velocity shows 2008 m/sec.

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Figure 3.

The result of axial length measurement at pre-cataract operation and pre-IOL exchange (aphakic/pseudophakic mode). (A)=aphakic mode; (B)=pseudophakic mode (lens velocity, 1,600 m/sec); (C)=pseudophakic mode (lens velocity, 2,000 m/sec); (D)=pseudophakic mode (lens velocity, 2,200 m/sec).

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Table 1.

Visual acuity at presentation of pre- and post-IOL exchange

Visual acuity∗	pre-IOL exchange	post-IOL exchange	p-value^†
Visual acuity∗	Visual acuity∗	No. of eyes〔 n (%)〕	p-value^†	No. of eyes〔 n (%)〕	p-value
<0.1		2 (14.3)	1 (7.1)
0.1-0.2		11 (78.6)	1 (7.1)
0.3-0.4		1 (7.1)	1 (7.1)
0.5-0.6			3 (21.4)
0.7-0.8			6 (42.9)
>0.8			2 (14.3)
Average	(LogMAR)	0.75±0.15	0.33±0.32	0.01

^∗ Visual acuity of Dr. Hahn’s standard test chart at 5 m

^† Wilcoxon signed rank test.

Table 2.

The results of measurement of axial length in opaque IOL (Mean±SD)

	Axial length (mm)	p-value∗
Pre-Cataract op.	23.40±0.69
IOL opacity
Aphakic mode	23.01±0.56	0.01
Pseudophakic mode
1,500 m/sec	23.05±0.57	0.02
1,550 m/sec	23.25±0.63	0.27
1,600 m/sec	23.39±0.65	0.88
1,650 m/sec	23.59±0.70	0.12
1,700 m/sec	23.69±0.57	0.04
1,750 m/sec	23.86±0.62	0.02
1,800 m/sec	24.01±0.57	0.00
1,850 m/sec	24.16±0.63	0.00
1,900 m/sec	24.33±0.60	0.00
2,000 m/sec	24.55±0.47	0.02
2,200 m/sec	25.21±0.67	0.03

^∗ Wilcoxon signed rank test, compared to pre-cataract op. axial length.

Table 3.

The results of axial length and keratometry at pre-cataract op. and post-IOL exchange

Patient	Pre-CA AL (mm)	Pseudophakic mode*	Keratometry (diopters)
Patient	Pre-CA AL (mm)	Pseudophakic mode*	Pre-op	IOL opacity
Pt. #1 - L	23.02	22.52	44.38	44.35
Pt. #2 - R	23.59	23.55	42.32	42.20
Pt. #2 - L	23.70	23.79	42.07	42.19
Pt. #3 - L	23.10	23.06	41.75	41.75
Pt. #4 - R	22.55	22.91	45.75	45.43
Pt. #5 - R	22.79	22.90	44.88	43.38
Pt. #6 - R	22.43	22.45	45.94	46.99
Pt. #7 - L	23.02	23.10	45.25	45.25
Pt. #8 - L	24.04	23.98	43.00	43.12
Pt. #9 - L	24.21	24.25	42.38	42.87
Pt. #10 - L	23.38	23.30	44.25	42.87
Pt. #11 - R	25.02	24.78	44.00	44.13
Pt. #11 - L	23.37	23.40	43.75	43.88
Pt. #12 - R	23.39	23.41	38.63	38.94
Average	23.40±0.69	23.38±0.65	43.45±1.95	43.38±1.93

Pre-CA=pre-cataract operation; AL=axial length.

Table 4.

Comparison between expected refractive error by axial length measured at pre-cataract, pre-IOL exchange (psuedophaki mode, 1,600 m/sec) and manifested refractive error at post-IOL exchange

Patient	Pre-Cataract	Pseudophakic mode	Post-IOL exchange (diopters)
Pt. #1 - L	-0.13	+1.13	-0.25
Pt. #2 - R	-0.13	-0.04	-0.13
Pt. #2 - L	-0.01	-0.20	-0.38
Pt. #3 - L	-0.11	-0.03	-
Pt. #4 - R	-0.18	-0.65	-
Pt. #5 - R	+0.08	-0.17	-0.75
Pt. #6 - R	-0.03	-0.08	-0.25
Pt. #7 - L	-0.12	-0.29	-0.50
Pt. #8 - L	-0.05	+0.07	-0.38
Pt. #9 - L	+0.12	+0.04	-0.25
Pt. #10 - L	+0.17	+0.34	+0.50
Pt. #11 - R	+0.06	+0.50	+0.25
Pt. #11 - L	+0.12	+0.05	+0.25
Pt. #12 - R	-0.05	-0.09	-
Average	-0.02±0.11	+0.04±0.41	-0.19±0.09
p-value∗		0.97	0.08

^- =unchecked

^‗ Wilcoxon signed rank test, compared to expected refractive error by axial length at pre-cataract operation.

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