Refractive Eerror According to the Anterior Chamber Depth and Corneal Refractive Power in Short Eyes

Jeong Ah Shin; Kyu Yeon Hwang; Man Soo Kim

doi:10.3341/jkos.2013.54.1.65

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Shin, Hwang, and Kim: Refractive Eerror According to the Anterior Chamber Depth and Corneal Refractive Power in Short Eyes

Original Article

J Korean Ophthalmol Soc 2013;54(1):65-71.

Published online: 25 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.1.65

Refractive Eerror According to the Anterior Chamber Depth and Corneal Refractive Power in Short Eyes

Jeong Ah Shin, MD, Kyu Yeon Hwang, MD, Man Soo Kim, MD, PhD

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Man Soo Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-1188, Fax: 82-2-2258-1173, E-mail: mskim@catholic.ac.kr

Received 4 May 2012 Accepted 2 August 2012

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 evaluate the accuracy of the chosen formula in short eyes and the effect of the anterior chamber depth (ACD) and corneal refractive power on the accuracy.

Methods

A total of 251 eyes out of 185 patients (axial length below 22.0 mm) who underwent cataract surgery in our hospital were retrospectively studied. Introcular lens (IOL) power was calculated with the Hoffer Q, SRK II, SRK-T and Holladay 1 formulas and refractive outcome was measured. Patients were divided into 2 groups based on ACD. The accuracy of the 4 formulas was compared and the errors according to the ACD were also evaluated.

Results

In eyes with short axial lengths, all formulas showed a tendency for hyperopic shifts. The Hoffer Q formula showed significantly high predictive accuracy. This tendency for hyperopic shifts was similar in the eyes with extremely short axial length, but a large refractive error deviation was observed. The 2 groups based on ACD showed no significant difference in the refractive error, but the group with deep ACD had a tendency for hyperopic shifts. The difference of the calculated IOL power between the 4 formulas was more pronounced in eyes with lower corneal refractive power.

Conclusions

In eyes with short axial lengths, preoperative ACD and corneal refractive power had an influence on the accuracies of predicted IOL power. Therefore, these factors should be considered in IOL power determination.

Keywords: Anterior chamber depth, Axial length, Corneal refractive power, Intraocular lens power calculation, Refractive outcome

References

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Figure 1.

Means and standard deviations of the absolute errors of the 4 intraocular lens calculation formulas.

Figure 2.

Means and standard deviations of the mean errors of the 4 intraocular lens calculation formulas.

Figure 3.

Means and standard deviations of the absolute errors of the 4 intraocular lens calculation formulas.

Figure 4.

Means and standard deviations of the mean errors of the 4 intraocular lens calculation formulas.

Figure 5.

Relationship between target IOL diopter and Keratometric reading.

Table 1.

The constants used in the four formulas in three intraocular lens (IOL) subtypes

		B&L Akreos AO MI60	AMO Tecnis ZA9003	Hoya AF-1 YA-60BBR
Fomula	Constant	89 eyes	64 eyes	98 eyes
SRK II	A Constant	118.9	119.1	118.4
SRK-T	A Constant	118.9	119.1	118.4
Holladay 1	Surgeon factor	1.44	1.61	1.84
Hoffer Q	pACD Constant	5.20	5.37	5.61

ACD = anterior chamber depth.

Table 2.

Preoperative characteristics and biometry

Group	All eyes	Short eyes	Extremely short eyes
No. (eyes)	251	212	39
Sex (M/F)	41/210	15/91	11/28
Age (yrs)	69.69 ± 14.11	69.95 ± 9.17	68.25 ± 8.71
Cataract (LOCS III)	2.2 ± 0.7	2.3 ± 0.5	2.0 ± 0.8
Axial length (mm)	21.07 ± 0.62	21.21 ± 0.34	20.29 ± 0.57
ACD (mm)	2.43 ± 0.22	2.47 ± 0.24	2.21 ± 0.19
K (D)	44.82 ± 0.56	44.60 ± 0.66	45.98 ± 0.73

Values are presented as mean ± SD.

LOCS III = Lens Opacities Classification System III; ACD = anterior chamber depth; K: corneal refractive power = keratometric diopter.

Table 3.

Mean numerical error (MNE) and Mean absolute error (MAE) according to intraocular lens power calculation formulas

Group	All eyes	Short eyes	Extremely short eyes
MNE (D, mean ± SD)
SRK II	–0.44 ± 0.61	–0.36 ± 0.82	–0.83 ± 0.66
SRK-T	–0.26 ± 0.56	–0.19 ± 0.25	–0.59 ± 0.33
Holladay 1	–0.20 ± 0.75	–0.13 ± 0.53	–0.66 ± 0.49
Hoffer Q	–0.19 ± 0.47	–0.12 ± 0.33	–0.46 ± 0.20
p-value^*	0.148	0.104	0.061
MAE (D, mean ± SD)
SRK II	0.81 ± 0.68	0.76 ± 0.34	1.08 ± 0.60
SRK-T	0.60 ± 0.42	0.57 ± 0.45	0.72 ± 0.59
Holladay 1	0.61 ± 0.42	0.57 ± 0.48	0.79 ± 0.55
Hoffer Q	0.37 ± 0.30	0.33 ± 0.21	0.56 ± 0.49
p-value^*	0.022	0.010	0.001

Values are presented as mean ± SD.

MNE = mean numeric error = the predicted postoperative diopter – actual postoperative diopter; MAE = mean absolute error = the mean absolute value of the numeric error.

^* Kruskal-Wallis test.

Table 4.

Characteristics of each group according to the anterior chamber depth (ACD)

Group	Group I^*	Group II^†	p-value^‡
No. (eyes)	115	136
ACD (mm)	2.23 ± 0.36	2.59 ± 0.21
Axial length (mm) length (mm)	20.95 ± 0.70	21.16 ± 0.69	0.415
K (D)	44.91 ± 0.19	44.74 ± 0.53	0.103
MNE (D, mean ± SD)
SRK/II	–0.56 ± 0.48	–0.45 ± 0.23	0.139
SRK-T	–0.29 ± 0.45	–0.22 ± 0.38	0.086
Holladay 1	–0.28 ± 0.55	–0.10 ± 0.53	0.033
Hoffer Q	–0.25 ± 0.62	–0.11 ± 0.63	0.057
p-value	0.294	0.127
MAE (D, mean ± SD)
SRK/II	0.85 ± 0.49	0.77 ± 0.61	0.154
SRK-T	0.63 ± 0.11	0.57 ± 0.46	0.464
Holladay 1	0.60 ± 0.19	0.61 ± 0.84	0.058
Hoffer Q	0.40 ± 0.45	0.34 ± 0.15	0.235
p-value	0.001	0.001

Values are presented as mean ± SD.

MNE = mean numeric error = the predicted postoperative diopter – actual postoperative diopter; MAE = mean absolute error = the mean absolute value of the numeric error.

^* Anterior chamber depth < 2.43 mm

^† Anterior chamber depth ≥ 2.43 mm

^‡ Paired t-test.

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