Ultrasound Biometry for Axial Length Measurement and Intraocular Lens Power Calculation Among Cataract Patients: Postoperative Refractive Results

Öz

Aim: To evaluate postoperative refractive outcomes of axial length and intraocular lens power measurements obtained by ultrasound biometry among cataract patients. Material and Methods: The files of consecutive senile cataract patients who underwent uncomplicated phacoemulsification surgery and completed postoperative 2 months follow-up were reviewed retrospectively. The eyes with ocular comorbidity, preoperative axial length shorter than 22.0 mm, or longer than 24.5 mm were excluded from the study. Axial length measurement was obtained by ultrasound biometry and intraocular lens power was calculated according to the SRK/T formula. Demographical and clinical data including axial length, keratometry, visual acuity, cataract localization and grade, manifest refraction, and postoperative refractive data were noted. Results: A total of 108 eyes of 82 patients with the mean age of 67.6±8.2 years were included in the study. Mean preoperative axial length and keratometric astigmatism were 23.04±0.65 mm and -0.34± 0.17 D, respectively. Mean target refraction was -0.12±0.15 D. At postoperative month-2, 73.1% of patients eyes had ≤0.25 D MR spherical equivalent. Mean absolute prediction error for postoperative refraction was 0.04±0.35 (0.04; -0.98-0.91) D, and there was no statistically significant correlation between absolute prediction error and cataract location, density, axial length, preoperative keratometry, visual acuity, or manifest refraction (p>0.05). Conclusion: Although modern cataract surgery and recent optical biometry methods offer excellent postoperative refractive outcomes, backup ultrasound contact biometry is still neccessary and provides satisfactory refractive outcomes.

Anahtar Kelimeler

• axial length
• cataract
• contact biometry
• intraocular lens power
• ocular biometry
• ultrasound biometry

Etik Beyan

The study was approved by the IRB Committee (number:2023/257, date:13.10.2023)and adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from each patient before enrollment.

Katarakt Cerrahisi Öncesi Göz İçi Lens Gücü Hesaplamasında Ultrasonik Biyometri: Postoperatif Refraktif Sonuçlar

Öz

Amaç: Bu çalışmada; katarakt cerrahisi öncesi ultrasonik biyometri yöntemi ile aksiyel uzunluk ölçümü ve göz içi lens gücü hesaplaması yapılan olgularda postoperatif refraktif sonuçların incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde senil katarakt tanısı ile cerrahi uygulanmış olgular retrospektif incelendi. Aksiyel uzunluk ve göz içi lens gücü ölçümlerinde ultrasonik kontakt biyometri kullanılan, fakoemülsifikasyon cerrahisi uygulanan ve peroperatif cerrahi komplikasyon gelişmeyen gözler çalışmaya dahil edildi. Ek oküler hastalığı bulunan veya aksiyel uzunluğu kısa (<22,0 mm) veya uzun (>24,5 mm) ölçülen gözler çalışmaya dahil edilmedi. Demografik verilerin yanısıra; keratometri ve aksiyel uzunluk ölçümleri, görme keskinlikleri (logMar), katarakt türü ve sertliği, SRK/T formülüne göre hesaplanmış göz içi lens gücü, preoperatif hedef refraksiyon ve postoperatif 2. ayda refraktif sonuçlar incelendi. Bulgular: Çalışmaya toplam 82 hastanın 108 gözü dahil edildi. Olguların %52,4’ü erkek ve ortalama yaş 67,6±8,2 yıl idi. Preoperatif ortalama aksiyel uzunluk 23.04±0.65 mm ve ortalama korneal astigmatizma -0,34± 0,17 D ölçüldü. Hedef postoperatif refraktif kusur ortalama -0,12±0,15 D idi. Postoperatif 2. ayda, olguların %73,1’inde ≤0,25 D manifest refraksiyon sferik eşdeğeri sağlandı. Hedef refraksiyona göre, ortalama 0,04±0,35 (0,04; -0,98-0,91) D refraktif sapma izlendi. Postoperatif refraktif sapma ile kataraktın sertliği ve anatomik lokalizasyonu, preoperatif görme keskinliği, korneal astigmatizma, manifest refraksiyon veya aksiyel uzunluk arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p>0,05). Sonuç: Modern cerrahi teknikler ve teknolojik gelişmeler sayesinde katarakt cerrahisi sonrası refraktif kusur oldukça azaltılsa da modern biyometri yöntemlerinin uygulanamadığı gözlerde ultrasonik biyometri ile aksiyel uzunluk hesaplanması tatmin edici refraktif sonuçlar sağlayabilmektedir.

Anahtar Kelimeler

• aksiyel uzunluk
• göz içi lens ölçümü
• katarakt
• kontakt biyometri
• oküler biyometri
• ultrasonik biyometri

Etik Beyan

Çalışma için Ordu Universitesi Tıp Fakültesi İnsan Araştırmaları Etik Kurulu’ndan etik onayı alındı (karar no:2023/257, tarih:13.10.2023), çalışma Helsinki Bildirgesi prensiplerine uygun olarak yürütüldü ve çalışma öncesi tüm hastalardan veya hasta yakınlarından aydınlatılmış onam alındı.

Kaynakça

1. 1. Olsen T. Calculation of intraocular lens power: a review. Acta Ophthalmol Scand. 2007;85(5):472-485. doi:10.1111/j.1755- 3768.2007.00879.x
2. 2. Kraff MC, Sanders DR, Lieberman HL. Determination of intraocular lens power: a comparison with and without ultrasound. Ophthalmic Surg. 1978;9(1):81-84.
3. 3. Falhar M, Rehák J. The contact and immersion ultrasound methods compared using the ray tracing method. Opt Appl. 2010;40(1):77-92.
4. 4. Chylack LT Jr, Leske MC, McCarthy D, Khu PM, Kashiwagi T, Sperduto, R. Lens Opacities Classification System II (LOCS II). Arch Ophthalmol. 1989;107:991-997. doi:10.1001/archopht. 1989.01070020053028
5. 5. Lee AC, Qazi MA, Pepose JS. Biometry and intraocular lens power calculation. Curr Opin Ophthalmol. 2008;19(1):13-17. doi:10.1097/ICU.0b013e3282f1c5ad
6. 6. Sahin A, Hamrah P. Clinically relevant biometry. Curr Opin Ophthalmol. 2012;23(1):47-53. doi:10.1097/ICU.0b013e32834cd63e
7. 7. Moshirfar M, Buckner B, Ronquillo YC, Hofstedt D. Biometry in cataract surgery: a review of the current literature. Curr Opin Ophthalmol. 2019;30(1):9-12. doi:10.1097/ ICU.0000000000000536
8. 8. Hoffmann PC, Hütz WW, Eckhardt HB, Heuring AH. [Intraocular lens calculation and ultrasound biometry: immersion and contact procedures]. Klin Monbl Augenheilkd. 1998;213(3):161- 165. doi:10.1055/s-2008-1034967

9. 9. Ossoinig KC. Standardized Echography. Int Ophthalmol Clin. 1979;19(4):127-210. doi:10.1097/00004397-197901940-00007
10. 10. Olsen T, Nielsen PJ. Immersion versus contact technique in the measurement of axial length by ultrasound. Acta Ophthalmol. 2009;67(1):101-102. doi:10.1111/j.1755-3768.1989. tb00732.x
11. 11. Hennessy MP, Chan DG. Contact versus immersion biometry of axial length before cataract surgery. J Cataract Refract Surg. 2003;29(11):2195-2198. doi:10.1016/S0886-3350(03)00224-4
12. 12. Lam AKC, Chan R, Pang PCK. The repeatability and accuracy of axial length and anterior chamber depth measurements from the IOLMaster. Ophthalmic Physiol Opt. 2001;21(6):477-483. doi:10.1046/j.1475-1313.2001.00611.x
13. 13. Findl O, Kriechbaum K, Sacu S, Kiss B, Polak K, Nepp J, Schild G, Rainer G, Maca S, Petternel V, Lackner B, Drexler W. Influence of operator experience on the performance of ultrasound biometry compared to optical biometry before cataract surgery. J Cataract Refract Surg. 2003;29(10):1950-1955. doi:10.1016/ S0886-3350(03)00243-8
14. 14. Gantenbein CPA, Ruprecht KW. Comparaison entre biométrie optique et acoustique de l’oeil. J Fr Ophtalmol. 2004;27(10):1121-1127. doi:10.1016/S0181-5512(04)96280-8
15. 15. El Chehab H, Giraud J-M, Le Corre A, Chave N, Durand F, Kuter S, Ract-Madoux G, Swalduz B, Mourgues G, Dot C. [Comparison between Lenstar LS 900 non-contact biometry and OcuScan RXP contact biometry for task delegation]. J Fr Ophtalmol. 2011;34(3):175-180. doi:10.1016/j.jfo.2010.09.026
16. 16. Aktas S, Aktas H, Tetikoglu M, Sagdk HM, Özcura F. Refractive Results Using a New Optical Biometry Device: Comparison With Ultrasound Biometry Data. Medicine (Baltimore). 2015;94(48):e2169. doi:10.1097/MD.0000000000002169
17. 17. Ademola-Popoola DS, Nzeh DA, Saka SE, Olokoba LB, Obajolowo TS. Comparison of ocular biometry measurements by applanation and immersion A-scan techniques. J Curr Ophthalmol. 2015;27(3-4):110-114. doi:10.1016/j.joco.2015.12.002
18. 18. Aydin R, Karaman Erdur S, Serefoglu Cabuk K, Karahan E, Kaynak S. Comparision of Optical Low Coherence Reflectometry Versus Ultrasonic Biometry in High Hypermetropia. Eye Contact Lens Sci Clin Pract. 2018;44(1):S115-S117. doi:10.1097/ICL.0000000000000350
19. 19. Rajan MS, Keilhorn I, Bell JA. Partial coherence laser interferometry vs conventional ultrasound biometry in intraocular lens power calculations. Eye. 2002;16(5):552-556. doi:10.1038/sj.eye. 6700157
20. 20. Hill W, Angeles R, Otani T. Evaluation of a new IOLMaster algorithm to measure axial length. J Cataract Refract Surg. 2008;34(6):920-924. doi:10.1016/j.jcrs.2008.02.021
21. 21. Wilson ME, Trivedi RH. Axial length measurement techniques in pediatric eyes with cataract. Saudi J Ophthalmol. 2012;26(1):13-17. doi:10.1016/j.sjopt.2011.11.002
22. 22. Pongsachareonnont P, Tangjanyatam S. Accuracy of axial length measurements obtained by optical biometry and acoustic biometry in rhegmatogenous retinal detachment: a prospective study. Clin Ophthalmol. 2018;Volume 12:973-980. doi:10.2147/ OPTH.S165875
23. 23. Kapoor M, Venkatesh P, Chawla R, Temkar S, Aggarwal E. Simplifying biometry in oil-filled eyes: A novel formula for axial length calculation in eyes with 1000 cSt silicone oil. Indian J Ophthalmol. 2023;71(6):2466-2468. doi:10.4103/ijo.IJO_2187_22
24. 24. Kimura S, Hosokawa MM, Shiode Y, Matoba R, Kanzaki Y, Goto Y, Kanenaga K, Suzuki E, Morizane Y. Accuracy of ultrasound vs. Fourier-domain optic biometry for measuring preoperative axial length in cases of rhegmatogenous retinal detachment. Jpn J Ophthalmol. August 2023:[Online ahead of print]. doi:10.1007/s10384-023-01018-2
25. 25. Brodie SE, Gupta PC, Irsch K, et al. Basic and Clinical Science Course, Section 3: Clinical Optics. In: Korn BS, Burkat CN, Carter KD, et al., eds. American Academy of Ophthalmology. San Francisco, CA: American Academy of Ophthalmology; 2018:239-266.
26. 26. Goel S, Chua C, Butcher M, Jones CA, Bagga P, Kotta S. Laser vs ultrasound biometry—a study of intra- and interobserver variability. Eye. 2004;18(5):514-518. doi:10.1038/sj.eye.6700705
27. 27. Martín-Serrano MJ, Roman-Ortiz C, Villa-Sáez ML, Labrador- Castellanos MP, Blanco-Carrasco R, Lozano-Ballesteros F, Pedraza-Martín C, José-Herrero MT, López-Ropero AM, Tenías Burillo JM. Concordance and Interchangeability of Biometric Measurements of Ocular Axial Length in Patients Awaiting Cataract Surgery. Eur J Ophthalmol. 2014;24(1):29-34. doi:10.5301/ejo.5000318
28. 28. Donaldson K, Fernández-Vega-Cueto L, Davidson R, Dhaliwal D, Hamilton R, Jackson M, Patterson L, Stonecipher K; ASCRS Refractive–Cataract Surgery Subcommittee. Perioperative assessment for refractive cataract surgery. J Cataract Refract Surg. 2018;44(5):642-653. doi:10.1016/j.jcrs.2018.02.022
29. 29. Symes RJ, Say MJ, Ursell PG. Scheimpflug keratometry versus conventional automated keratometry in routine cataract surgery. J Cataract Refract Surg. 2010;36(7):1107-1114. doi: 10.1016/j.jcrs.2009.11.026