Refractory Outcomes after Cataract Surgery in Acute Primary Angle-closure Glaucoma Patients Treated with Laser Iridotomy

Hye Seong Hwang; Dong Yoon Kim; Hyun Tae Kim; Ju Byung Chae; Sungmin Hyung

doi:10.3341/jkos.2019.60.5.447

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Hwang, Kim, Kim, Chae, and Hyung: Refractory Outcomes after Cataract Surgery in Acute Primary Angle-closure Glaucoma Patients Treated with Laser Iridotomy

Original Article

J Korean Ophthalmol Soc 2019;60(5):447-454.

Published online: 25 September 2019

DOI: https://doi.org/10.3341/jkos.2019.60.5.447

Refractory Outcomes after Cataract Surgery in Acute Primary Angle-closure Glaucoma Patients Treated with Laser Iridotomy

Hye Seong Hwang, MD, Dong Yoon Kim, MD, PhD, Hyun Tae Kim, MD, Ju Byung Chae, MD, PhD, Sungmin Hyung, MD, PhD

Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Sungmin Hyung, MD, PhD Department of Ophthalmology, Chungbuk National University Hospital, #776 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea Tel: 82-43-269-6368, Fax: 82-43-264-5263 E-mail: smh@chungbuk.ac.kr

Received 25 October 2018 Revised 2 January 2019 Accepted 25 April 2019

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 analyze the accuracy of ocular biometry and prediction of postoperative refraction after cataract surgery in acute primary angle-closure glaucoma (ACG) patients treated with laser iridotomy (LI).

Methods

We retrospectively reviewed the medical records of 44 patients who underwent cataract surgery after LI due to ACG (ACG group), and 37 patients who underwent cataract surgery without ocular disease other than cataract (control group) from January 2015 to May 2018. An Acrysof ^® single piece (SN60WF) was used as the intraocular lens. We performed preoperative ocular biometry and intraocular lens power calculations using AL-Scan^®. The accuracy of the postoperative refractive power prediction was analyzed according to the anterior chamber depth (ACD) and axial length (AL).

Results

The preoperative ACD was 2.29 ± 0.32 mm in the ACG group and 3.15 ± 0.27 mm in the control group (p < 0.01), and the respective AL values were 22.53 ± 0.80 mm and 23.87 ± 1.38 mm (p < 0.01). Using the Haigis formula, patients with an ACD < 2.30 mm in the ACG group (0.52 ± 0.36 diopters [D]) had less accurate results in terms of the mean absolute error than patients with an ACD > 2.31 mm in the ACG group (0.27 ± 0.20 D) and control group (0.27 ± 0.20 D). There was no significant difference in the mean absoluter error between each formula in patients with an AL of < 22.0 mm or > 22.1 mm in the ACG and control groups.

Conclusions

Among patients treated with LI due to ACG, those patients with an ACD > 2.31 mm showed no difference in refractory prediction compared to the control group. However, in patients with an ACD < 2.30 mm, the refractory prediction may be inaccurate when using the Haigis formula, a fourth-generation formula that takes into account the ACD.

Keywords: AL-Scan^®, Angle-closure glaucoma, Anterior chamber, Axial length, Refractive errors

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Figure 1.

Comparison of various IOL power calculation formulas according to anterior chamber depth. Stacked histogram compare the percentage of eyes within a given diopter range of predicted spherical equivalent refraction outcome. A-C indicated group A, group B, and control group individually. IOL = intraocular lens; D=diopter.

Table 1.

Characteristics of enrolled patients

	All	ACG group	Control group	p-value
Number	81	44	37
Sex (M/F)		9/35	14/23	0.137^*
Right/left		16/28	15/22	0.819^*
Age (years)	69.89 ± 7.52	69.20 ± 6.81	70.70 ± 8.32	0.375^†
BCVA (logMAR)	0.42 ± 0.28	0.38 ± 0.20	0.48 ± 0.35	0.117^†
IOP (mmHg)	14.67 ± 3.44	14.95 ± 4.05	14.32 ± 2.56	0.415^†
Spherical equivalent (D)	−0.07 ± 1.80	0.14 ± 0.16	−0.33 ± 1.97	0.238^†
K 3.3 (D)	44.47 ± 1.65	44.86 ± 1.77	44.11 ± 1.43	0.079^†
K 2.3 (D)	44.53 ± 1.65	44.78 ± 1.78	44.14 ± 1.43	0.096^†
Axial length (mm)	23.14 ± 1.29	22.53 ± 0.80	23.87 ± 1.38	<0.001^†
ACD (mm)	2.68 ± 0.53	2.29 ± 0.32	3.15 ± 0.27	<0.001^†
IOL power (D)	21.59 ± 3.19	23.11 ± 1.85	19.77 ± 3.51	<0.001^†

Values are presented as mean ± standard deviation or number unless otherwise indicated.

M/F = male/female; BCVA = best-corrected visual acuity; logMAR = logarithm of minimal angle of resolution; IOP = intra ocular pressure; D = diopter; K 3.3 = keratometry calculated at corneal radius 3.3 mm; K 2.3 = keratometry calculated at corneal radius 2.3 mm; ACD = anterior chamber depth; IOL = intraocular lens.

^* Determined using the Fisher's exact test

^† determined using the Mann-Whitney U-test.

Table 2.

Mean absolute error: comparison of various IOL power calculation formulas according to anterior chamber depth

Group	Mean absolute error (diopter)					p-value^*
Group	SRK II	SRK/T	Hoffer Q	Haigis	Holladay 1	p-value^*
Total	0.59 ± 0.44	0.38 ± 0.28	0.35 ± 0.25	0.34 ± 0.27	0.31 ± 0.20	<0.001
	(0.01–1.86)	(0.00–1.42)	(0.00–1.00)	(0.01–1.21)	(0.00–0.99)
Group A	0.78 ± 0.53	0.48 ± 0.32	0.43 ± 0.28	0.52 ± 0.36	0.39 ± 0.26	0.067
	(0.07–1.86)	(0.00–1.42)	(0.00–0.87)	(0.07–1.21)	(0.00–0.99)
Group B	0.60 ± 0.39	0.36 ± 0.27	0.34 ± 0.26	0.27 ± 0.20	0.31 ± 0.19	0.017
	(0.11–1.54)	(0.03–0.84)	(0.00–0.90)	(0.02–0.67)	(0.03–0.75)
Control	0.47 ± 0.36	0.33 ± 0.24	0.31 ± 0.22	0.27 ± 0.20	0.31 ± 0.20	0.139
	(0.01–1.86)	(0.00–0.85)	(0.01–1.00)	(0.01–0.79)	(0.01–0.72)
p-value^*	0.050	0.183	0.334	0.011	0.535

Values are presented as mean ± standard deviation (range) unless otherwise indicated.

^* Kruskal-Wallis test.

Table 3.

Mean error: comparison of various IOL power calculation formulas according to anterior chamber depth

Group	Mean absolute error (diopter)					p-value^*
Group	SRK II	SRK/T	Hoffer Q	Haigis	Holladay 1	p-value^*
Total	0.44 ± 0.59	0.20 ± 0.42	−0.11 ± 0.42	0.03 ± 0.43	−0.06 ± 0.39	<0.001
	(−1.46 to 1.86)	(−0.63 to 1.42)	(−0.90 to 1.00)	(−0.64 to 1.21)	(−0.76 to 0.99)
Group A	0.76 ± 0.56	0.36 ± 0.46	−0.08 ± 0.51	0.35 ± 0.53	0.02 ± 0.47	<0.001
	(−0.15 to 1.86)	(−0.47 to 1.42)	(−0.83 to 0.87)	(−0.47 to 1.21)	(−0.76 to 0.99)
Group B	0.52 ± 0.50	0.16 ± 0.42	−0.24 ± 0.35	0.01 ± 0.34	−0.14 ± 0.35	<0.001
	(−0.57 to 1.54)	(−0.63 to 0.84)	(−0.90 to 0.54)	(−0.63 to 0.67)	(−0.75 to 0.48)
Control	0.20 ± 0.56	0.13 ± 0.39	−0.06 ± 0.38	−0.08 ± 0.33	−0.07 ± 0.38	<0.001
	(−1.46 to 1.11)	(−0.42 to 0.85)	(−0.75 to 1.00)	(−0.64 to 0.79)	(−0.69 to 0.72)
p-value^*	0.002	0.172	0.231	0.006	0.526

Values are presented as mean ± standard deviation (range) unless otherwise indicated. IOL = intraocular lens.

^* Kruskal-Wallis test.

Table 4.

Refractive results (diopter): comparison of various intraocular lens power calculation formulas according to anterior chamber depth

Group	Formula	Over 1.0 D myopia^*	Over 0.5 D myopia^†	Over 0.5 D hyperopia^‡	Over 1.0 D hyperopia^§
Group A	SRK II	0.00	0.00	63.64	31.82
	SRK/T	0.00	0.00	40.91	4.55
	Hoffer Q	0.00	27.27	9.09	0.00
	Haigis	0.00	0.00	40.91	18.18
	Holladay 1	0.00	18.18	18.18	0.00
Group B	SRK II	0.00	4.55	45.45	18.18
	SRK/T	0.00	4.55	27.27	0.00
	Hoffer Q	0.00	22.73	4.55	0.00
	Haigis	0.00	9.09	9.09	0.00
	Holladay 1	0.00	13.64	0.00	0.00
Control	SRK II	2.70	5.41	32.14	10.81
	SRK/T	0.00	0.00	18.92	0.00
	Hoffer Q	0.00	8.11	10.81	0.00
	Haigis	0.00	13.51	2.70	0.00
	Holladay 1	0.00	8.11	8.11	0.00

Values are presented as %.

D = diopter.

^* Percentage of eye which was myopic shift over 1.0 D from intended refraction

^† percentage of eye which was myopic shift over 0.5 D from intended refracton

^‡ percentage of eye which was hyperopic shift over 0.5 D from intended refraction

^§ percentage of eye which was hyperopic shift over 1.0 D from intended refraction.

Table 5.

Mean absolute error: comparison of various IOL power calculation formulas according to axial length

Group	Mean absolute error (diopter)					p-value^*
Group	SRK II	SRK/T	Hoffer Q	Haigis	Holladay 1	p-value^*
Group C	0.58 ± 0.38	0.37 ± 0.26	0.41 ± 0.29	0.44 ± 0.33	0.34 ± 0.20	0.487
	(0.15–1.37)	(0.06–0.85)	(0.00–0.89)	(0.02–1.21)	(0.08–0.65)
Group D	0.74 ± 0.50	0.44 ± 0.31	0.37 ± 0.27	0.37 ± 0.32	0.35 ± 0.24	0.004
	(0.07–1.86)	(0.00–1.42)	(0.00–0.90)	(0.03–1.19)	(0.00–0.99)
Control	0.47 ± 0.36	0.33 ± 0.24	0.31 ± 0.22	0.27 ± 0.20	0.31 ± 0.20	0.139
	(0.01–1.86)	(0.00–0.85)	(0.01–1.00)	(0.01–0.79)	(0.01–0.72)
p-value^*	0.064	0.347	0.480	0.186	0.782

Values are presented as mean ± standard deviation (range) unless otherwise indicated.

^* Kruskal-Wallis test.

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