Korean J Ophthalmol.  2008 Dec;22(4):214-219. 10.3341/kjo.2008.22.4.214.

Prediction of Refractive Error in Combined Vitrectomy and Cataract Surgery With One-Piece Acrylic Intraocular Lens

• Lee DK
• Lee SJ
• You YS

• KMID: 1084207
• DOI: http://doi.org/10.3341/kjo.2008.22.4.214

Abstract

PURPOSE: To compare the predicted and actual refractive errors of hydrophilic, one-piece, C-flex(R)570C (C-flex) intraocular lens (IOL) implantation in simultaneous vitrectomy and lens extraction in various conditions. METHODS: One hundred fifty-nine eyes of patients who had lens extraction between March 2004 and September 2005 were enrolled in a retrospective study. Group 1 had lens extraction and IOL implantation, and Group 2 had lens extraction and IOL implantation with vitrectomy. IOL calculation was done with axial length and keratometry measurements. The actual and predicted refractive errors were compared at 1 and 6 months postoperatively. The factors influencing the postoperative refractive outcomes were analyzed. RESULTS: The mean refractive predictive error (i.e., the actual minus predicted spherical equivalent) was +0.19+/-0.39 D (Diopter) and -0.26+/-0.45 D at 1 and 6 months postoperatively (all: p<0.001) in group 1, and -0.22+/-0.39 D and -0.06+/-0.62 D at 1 and 6 months postoperatively (p=0.013, p=0.399 respectively). In group 2, all surgical factors related to refractive errors were not statistically significant (all: p>0.05). CONCLUSIONS: Refractive errors in combined surgery showed myopic shift of -0.50 D and -0.32 D at 1 and 6 months postoperatively compared with C-flex IOL implantation alone. With the hyperopic tendency of IOL and myopic tendency of vitrectomy, the combined surgery made postoperative refractive errors near emmetropia.

Keyword

Cataract surgery; Hydrophilic acrylic intraocular lens; Refractive errors; Vitrectomy

MeSH Terms

Acrylic Resins
Aged
Humans
*Lens Implantation, Intraocular
Lenses, Intraocular
Middle Aged
Phacoemulsification/*methods
Refractive Errors/*diagnosis
Retrospective Studies
Vitrectomy/*methods

Figure

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  Fig. 1 The C-flex 570C IOL with an enhanced 360-degree, square-edged design. (From Nishi Y et al. J Cataract Refract Surg 2007;33:227-31)

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  Fig. 2 Changes of predicted SE and actual SE in Group 1 and Group 2 at 1 month and 6 months postoperatively. Group 1 was shifted more hyperopic than predicted values at 1 month and 6 months. Group 2, on other hand, was shifted more myopic at 1 month but more hyperopic at 6 months. Group 2 was closer to predicted refractive errors.

Reference

1. Demetriades AM, Gottsch JD, Thomsen R, et al. Combined phacoemulsification, intraocular lens implantation and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol. 2003. 135:291–296.

2. Senn P, Schipper I, Perren B. Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation in the capsular bag: a comparison to vitrectomy and subsequent cataract surgery as a two-step procedure. Ophthalmic Surg Lasers. 1995. 26:420–428.

3. Honjo M, Ogura Y. Surgical results of pars plana vitrectomy combined with phacoemulsification and intraocular lens implantation for complications of proliferative diabetic retinopathy. Ophthalmic Surg Lasers. 1998. 29:99–105.

4. Scharwey K, Pavlovic S, Jacobi KW. Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation. J Cataract Refract Surg. 1999. 25:693–698.

5. Koenig SB, Han DP, Mieler WF, et al. Combined phacoemulsification and pars plana vitrectomy. Arch Ophthalmol. 1990. 108:362–364.

6. Nishi Y, Rabsilber TM, Limberger IJ, et al. Influence of 360-degree enhanced optic edge design of a hydrophilic acrylic intraocular lens in posterior capsule opacification. J Cataract Refract Surg. 2007. 33:227–231.

7. Vyas AV, Narendran R, Bacon PJ, Apple DJ. Three-hundred-sixty degree barrier effect of a square-edged and an enhanced-edge intraocular lens on centripetal lens epithelial cell migration; Two-year results. J Cataract Refract Surg. 2007. 33:81–87.

8. Werner L, Mamalis N, Pandey SK, et al. Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge. J Cataract Refract Surg. 2004. 30:2403–2409.

9. Kleinmann G, Apple DJ. Evaluation of a new soft tipped injector for the implantation of foldable intraocular lenses. Br J Ophthalmol. 2007. 91:1070–1072.

10. Taskapili M, Gulkilik G, Engin G, et al. Transscleral fixation of a single-piece hydrophilic foldable acrylic intraocular lens. Can J Ophthalmol. 2007. 42:256–261.

11. Oner FH, Saatci OA, Sarioğlu S, et al. Interaction of intraocular lenses with various concentrations of silicone oil: an experimental study. Ophthalmologica. 2003. 217:124–128.

12. Steinert RF, Brint SF, White SM, Fine IH. Astigmatism after small incision cataract surgery: a prospective, ramdomized, multicenter comparison of 4-and 6.5-mm incisions. Ophthalmology. 1991. 98:417–424.

13. Levy JH, Pisacano AM, Chadwick K. Astigmatism changes after cataract surgery with 5.1mm and 3.5mm sutureless incision. J Cataract Refract Surg. 1994. 20:630–633.

14. Menapace R, Yalon M. Exchange of IOGEL hydrogel one piece foldable intraocular lenses for bag-fixated J-loop poly (methylmethacrylate) intraocular lens. J Cataract Refract Surg. 1993. 19:425–430.

15. Olsen T. Sources of error in intraocular lens power calculation. J Cataract Refract Surg. 1992. 18:125–129.

16. McEwan JR, Massengil RK, Friedel SD. Effect of keratometer and axial length measurement errors in primary implant power calculations. J Cataract Refract Surg. 1990. 16:61–70.

17. Hoffer KJ. Modern IOL power calculations: Avoiding error and planning for special circumstances. Focal Point. 1999. 17:12.

18. Holladay JT. Standardising constants for ultrasonic biometry, keratometry and intraocular lens power calculations. J Cataract Refract Surg. 1997. 23:1356–1370.

19. Assia EI, Legler UFC, Castaneda VE, Apple DJ. Loop memory of posterior chamber intraocular lenses of various size, and loop materials. J Cataract Refract Surg. 1992. 18:541–546.

20. Chang JH, Lim SJ, Kim HB. Clinical evaluation of AMO Phacoflex SI-30NB in the aspect of A-constant. J Korean Ophthalmol Soc. 1999. 40:987–994.

21. Kim YE, Cho BJ, Lee KS. The evaluation of the difference between the calculated estimated post-operative refraction and the real post-operative refraction for five types intraocular lenses. J Korean Ophthalmol Soc. 2003. 44:1059–1065.

22. Na SJ, Park JS, Choi SK. Clinical Results of Centerflex® intraocular ocular lenses and Acrysof® intraocular ocular lenses in bilateral cataracts. J Korean Ophthalmol Soc. 2004. 45:1066–1074.

23. Kim JY, Tchah HW. The clinical results of hydrophilic acrylic lens. J Korean Ophthalmol Soc. 2001. 42:1562–1570.

24. Kim JH, Kang SM. Comparison of scleral tunnel and clear cornea incision in phacoemulsification combined with pars plana vitrectomy. J Korean Ophthalmol Soc. 2006. 47:1583–1588.

25. Danjo Y, Matsuda H, Maeno T, et al. Catatact surgery for avitreous eyes-postoperative refractive prediction folia. Ophthalmologica Japonica. 1993. 44:1243–1247.

26. Suzuki Y, Sakuraba T, Mizutani H, et al. Postoperative refractive error after simultaneous vitrectomy and cataract surgery. Ophthalmic Surg Lasers. 2000. 31:271–275.

27. Shioya M, Ogino N, Shinjo U. Change in postoperative refractive error when vitrectomy is added to intraocular lens implantation. J Cataract Refract Surg. 1997. 23:1217–1220.

28. Nishigaki S, Inaba I, Minami H, et al. The postoperative change of depth of anterior chamber, refraction and anterior capsulorhexis size after intraocular lens implantation. Nippon Ganka Gakkai Zasshi. 1996. 100:156–158.

29. Kim DH, Kim SK, Koh HJ, Kwon OW. Postoperative refractive error in combined operation of vitrectomy and intraocular lens implantation. J Korean Ophthalmol Soc. 2002. 43:1644–1648.

30. Choi YJ, Kim CG, Kim SH. Postoperative refractive error after vitrectomy in macular hole patients. J Korean Ophthalmol Soc. 2003. 44:1813–1817.

31. Jeoung JW, Chung H, Yu HG. Factors influencing refractive outcomes after combined phacoemulsification and pars plana vitrectomy Results of a prospective study. J Cataract Refract Surg. 2007. 33:108–114.

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