Accuracy of Predictive Refraction in Combined Vitrectomy-Cataract Surgery for Epiretinal Membrane and Macular Hole

Hyo Cheol Lim; Kyung Ho Kim; Min Kyu Shin; Sung Who Park; Ik Soo Byon; Ji Eun Lee

doi:10.3341/jkos.2015.56.2.219

Journal List > J Korean Ophthalmol Soc > v.56(2) > 1010189

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lim, Kim, Shin, Park, Byon, and Lee: Accuracy of Predictive Refraction in Combined Vitrectomy-Cataract Surgery for Epiretinal Membrane and Macular Hole

Original Article

J Korean Ophthalmol Soc 2015;56(2):219-227.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.219

Accuracy of Predictive Refraction in Combined Vitrectomy-Cataract Surgery for Epiretinal Membrane and Macular Hole

Hyo Cheol Lim, MD¹, Kyung Ho Kim, MD¹, Min Kyu Shin, MD², Sung Who Park, MD², Ik Soo Byon, MD^1,^3,, Ji Eun Lee, MD, PhD^2,⁴

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

³Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

⁴Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Ik Soo Byon, MD, Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea, Tel: 82-55-360-2592, Fax: 82-55-360-2161 E-mail: isbyon@naver.com

Received 28 March 201430 October 2014 Accepted 28 January 2015

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 predictive refraction and the factors influencing the predictability in combined vitrectomy and cataract surgery.

Methods

We retrospectively investigated patients who received combined vitrectomy and cataract surgery for idiopathic epiretinal membrane (ERM) and macular hole (MH), followed up for a minimum of 6 months. Preoperative refraction, target refraction, post-operative refraction, predictive refraction error (target refraction - postoperative refraction), accuracy of predictive refraction error (predictive refraction error was within ±0.5 diopter), intraocular pressure, axial length, central macular thickness, and tools that were used for intraocular lens power calculation (A-scan and IOL master) were assessed by analyzing medical records.

Results

A total of 176 eyes (including 132 idiopathic ERM cases and 44 MH cases) were included in this study. The accuracy of predictive refraction error was 60.8% at 6 months and there was no difference between the idiopathic epiretinal membrane group (59.8%) and the macular hole group (63.6%). There was no significant difference in predictive refraction error according to axial length and tools (IOL master vs A-scan). Predictive refraction error correlated positively with preoperative refraction (r = 0.227; p = 0.002). In the ERM group, predictive refraction error correlated negatively with both preoperative central macular thickness and the change in central macular thickness between, before, and 6 months after surgery (r = -0.211; p = 0.015 and r = -0.241; p = 0.005).

Conclusions

The accuracy of predictive refraction error was approximately 60% in combined vitrectomy and cataract surgery. Postoperative refraction appeared to be myopia relative to target refraction with higher preoperative myopia and thicker pre-operative central macular thickness. Hence, the intraocular lens power should be determined considering the above factors. J Korean Ophthalmol Soc 2015;56(2):219-227

Keywords: Accuracy of predictive refraction, Combined vitrectomy and cataract surgery, Predictive refraction error, Refractive error

References

1. Cherfan GM, Michels RG, de Bustros S. . Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker. Am J Ophthalmol. 1991; 111:434–8.

2. Melberg NS, Thomas MA. Nuclear sclerotic cataract after vitrectomy in patients younger than 50 years of age. Ophthalmology. 1995; 102:1466–71.

3. Pinter SM, Sugar A. Phacoemulsification in eyes with past pars plana vitrectomy: case-control study. J Cataract Refract Surg. 1999; 25:556–61.

4. Grusha YO, Masket S, Miller KM. Phacoemulsification and lens implantation after pars plana vitrectomy. Ophthalmology. 1998; 105:287–94.

5. Demetriades AM, Gottsch JD, Thomsen R. . Combined pha-coemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol. 2003; 135:291–6.

6. Gu BY, Sagong M, Chang WH. Phacovitrectomy versus vitrectomy only for primary rhegmatogenous retinal detachment repair. J Korean Ophthalmol Soc. 2011; 52:537–43.

7. Koenig SB, Mieler WF, Han DP, Abrams GW. Combined phacoe-mulsification, pars plana vitrectomy, and posterior chamber intra-ocular lens insertion. Arch Ophthalmol. 1992; 110:1101–4.

8. Wensheng L, Wu R, Wang X. . Clinical complications of combined phacoemulsification and vitrectomy for eyes with coexisting cataract and vitreoretinal diseases. Eur J Ophthalmol. 2009; 19:37–45.

9. Theocharis IP, Alexandridou A, Gili NJ, Tomic Z. Combined pha-coemulsification and pars plana vitrectomy for macular hole treatment. Acta Ophthalmol Scand. 2005; 83:172–5.

10. Zheng QX, Wu RH, Zhang YP. . Anterior segment complications after phacoemu-lsification combined vitrectomy and foldable intraocular lens implantation. Int J Ophthalmol. 2010; 3:249–54.

11. Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology. 1983; 90:522–30.

12. Hutton WL, Pesicka GA, Fuller DG. Cataract extraction in the diabetic eye after vitrectomy. Am J Ophthalmol. 1987; 104:1–4.

13. Legarreta JE, Gregori G, Punjabi OS. . Macular thickness measurements in normal eyes using spectral domain optical coherence tomography. Ophthalmic Surg Lasers Imaging. 2008; 39(4 Suppl):S43–9.

14. Kakinoki M, Sawada O, Sawada T. . Comparison of macular thickness between Cirrus HD-OCT and Stratus OCT. Ophthalmic Surg Lasers Imaging. 2009; 40:135–40.

15. Elder MJ. Predicting the refractive outcome after cataract surgery: the comparison of different IOLs and SRK-II v SRK-T. Br J Ophthalmol. 2002; 86:620–2.

16. Lee DK, Lee SJ, You YS. Prediction of refractive error in combined vitrectomy and cataract surgery with onepiece acrylic intraocular lens. Korean J Ophthalmol. 2008; 22:214–9.

17. 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 pro-spective controlled clinical trial. J Cataract Refract Surg. 2008; 34:1754–60.

18. Murphy C, Tuft SJ, Minassian DC. Refractive error and visual out-come after cataract extraction. J Cataract Refract Surg. 2002; 28:62–6.

19. Kovács I, Ferencz M, Nemes J. . Intraocular lens power calculation for combined cataract surgery, vitrectomy and peeling of epiretinal membranes for macular oedema. Acta Ophthalmol Scand. 2007; 85:88–91.

20. Patel D, Rahman R, Kumarasamy M. Accuracy of intraocular lens power estimation in eyes having phacovitrectomy for macular holes. J Cataract Refract Surg. 2007; 33:1760–2.

21. Schweitzer KD, Garcia R. Myopic shift after combined phacoe-mulsification and vitrectomy with gas tamponade. Can J Ophthalmol. 2008; 43:581–3.

22. Hwang HS, Jee D. Effects of the intraocular lens type on refractive error following phacovitrectomy with gas tamponade. Curr Eye Res. 2011; 36:1148–52.

23. Kiss B, Findl O, Menapace R. . Biometry of cataractous eyes using partial coherence interferometry: clinical feasibility study of a commercial prototype I. J Cataract Refract Surg. 2002; 28:224–9.

24. Tehrani M, Krummenauer F, Kumar R, Dick HB. Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound. J Cataract Refract Surg. 2003; 29:747–52.

25. 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.

26. 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.

27. 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.

28. Lee JT, Song JS, Kim HM. The accuracy of axial length measurement using partial coherence interferometry. J Korean Ophthalmol Soc. 2003; 44:812–7.

29. Rajan MS, Keilhorn I, Bell JA. Partial coherence laser inter-ferometry vs conventional ultrasound biometry in intraocular lens power calculations. Eye (Lond). 2002; 16:552–6.

30. Drexler W, Findl O, Menapace R. . Partial coherence inter-ferometry: a novel approach to biometry in cataract surgery. Am J Ophthalmol. 1998; 126:524–34.

31. Haigis W, Lege B, Miller N, Schneider B. Comparison of immersion ultrasound biometry and partial coherence interferometry for intraocular lens calculation according to Haigis. Graefes Arch Clin Exp Ophthalmol. 2000; 238:765–73.

32. Galway G, Drury B, Cronin BG, Bourke RD. A comparison of induced astigmatism in 20- vs 25-gauge vitrectomy procedures. Eye (Lond). 2010; 24:315–7.

33. Okamoto F, Okamoto C, Sakata N. . Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy. Ophthalmology. 2007; 114:2138–41.

34. Zhang ZH, Liu HY, Wimpissinger B. . Transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery: a meta-analysis of randomized controlled trials. Graefes Arch Clin Exp Ophthalmol. 2013; 251:681–8.

35. Lee JE, Kim KH, Kim IK. . Comparison of 20-gauge trans-conjunctival sutureless vitrectomy with conventional vitrectomy. Retina. 2010; 30:1496–504.

36. Hikichi T, Matsumoto N, Ohtsuka H. . Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane. Am J Ophthalmol. 2009; 147:639–43.e1.

37. Lim LH, Lee SY, Ang CL. Factors affecting the predictability of SRK II in patients with normal axial length undergoing phacoe-mulsification surgery. Singapore Med J. 2009; 50:120–5.

38. Lee YE, Choi KR, Jun RM. Accuracy of intraocular lens power calculations according to the formulas and anterior chamber depth in short eyes. J Korean Ophthalmol Soc. 2010; 51:1338–44.

39. Dick HB, Budo C, Malecaze F. . Foldable Artiflex phakic intra-ocular lens for the correction of myopia: two-year follow-up results of a prospective European multicenter study. Ophthalmology. 2009; 116:671–7.

40. Shioya M, Ogino N, Shinjo U. Change in postoperative refractive error when vitrectomy is added to intraocular lens implantation. J Cataract Refract Surg. 1997; 23:1217–20.

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

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

43. Kalogeropoulos C, Aspiotis M, Stefaniotou M, Psilas K. Factors influencing the accuracy of the SRK formula in the intraocular less power calculation. Doc Ophthalmol. 1994; 85:223–42.

44. Prinz A, Neumayer T, Buehl W. . Influence of severity of nuclear cataract on optical biometry. J Cataract Refract Surg. 2006; 32:1161–5.

45. Freeman G, Pesudovs K. The impact of cataract severity on measurement acquisition with the IOLMaster. Acta Ophthalmol Scand. 2005; 83:439–42.

Figure 1.

Correlation between axial length and predictive refraction error. There was a weak negative correlation 3 months (A) (r = -0.153, p = 0.042) and 6 months after surgery (B) (r = -0.148, p = 0.05).

Figure 2.

Correlation between preoperative refraction and predictive refraction error. There was a positive correlation at 3 months (r = 0.208, p = 0.006) (A) and 6 months (r = 0.227, p = 0.002) (B).

Figure 3.

Correlation between preoperative central macular thickness and predictive refraction error. There were negative correlations between preoperative central macular thickness and predictive refraction error (r = -0.212; p = 0.015 and r = -0.211; p = 0.015).

Figure 4.

Correlation between change of central macular thickness and predictive refraction error. There were negative correlations between change of central macular thickness and predictive refraction error (r = -0.222; p = 0.01 and r = -0.241; p = 0.005) at 3 (A) and 6 (B) months.

Table 1.

Difference between accuracy of predictive refract- ionerror after combined vitrectomy and cataract surgery

	Accuracy of predictive refraction error^∗ (%)
	3 months	6 months
Total	52.3	60.8
Disease
ERM	52.3	59.8
MH	52.3	63.6
p-value^∗	1	0.656
Test equipment
IOL master	49.5	58.3
A-scan	56.2	64.4
p-value^∗	0.384	0.412

ERM = epiretinal membrane; MH = macular hole; IOL = intraocular lens.

^∗ Actual postoperative refraction minus target refraction (spherical equivalent) <±0.5 D, Chi-square test.

Table 2.

Predictive refraction error (postoperative refraction minus target refraction) in ERM and MH patients according to test equipment

		Predictive refraction error (diopter)
		3 months	6 months
Total		-0.20 ± 0.77	-0.18 ± 0.77
ERM		-0.16 ± 0.72	-0.15 ± 0.76
	IOL master	-0.24 ± 0.76	-0.24 ± 0.81
	A-scan	-0.06 ± 0.67	-0.03 ± 0.67
	p-value^∗	0.274	0.175
MH		-0.32 ± 0.89	-0.26 ± 0.83
	IOL master	-0.34 ± 0.91	-0.29 ± 0.87
	A-scan	-0.28 ± 0.87	-0.23 ± 0.78
	p-value^∗	0.751	0.798
p-value^†		0.358	0.95

Values are presented as mean ± SD. ERM = epiretinal membrane; MH = macular hole; IOL = intraocular lens.

^∗ Comparison of predictive refraction error between A-scan and IOL master within subgroups by Mann-Whitney U test

^† Comparison of predictive refraction error between ERM group and MH group by Mann-Whitney U test.

Table 3.

Predictive refraction error (postoperative refraction minus target refraction) in ERM and MH patients according to surgical procedure

	Predictive refraction error (diopter) (6 months)
	ERM	MH
23G vitrectomy	-0.11 ± 0.80	-0.26 ± 0.76
25G vitrectomy	-0.27 ± 0.63	-0.15 ± 0.48
p-value^∗	0.121	0.087
Sutured	-0.11 ± 0.76	-0.38 ± 0.87
Sutureless	-0.23 ± 0.75	-0.24 ± 0.56
p-value^∗	0.097	0.064

Values are presented as mean ± SD. ERM = epiretinal membrane; MH = macular hole.

^∗ Comparison of predictive refraction error according to the surgical procedures in ERM group and MH group by Mann-Whitney U test.

TOOLS

Similar articles