Biometric Accuracy in High Hypermetropes and Myopes Mangat S, Kumar B V, Prasad S Arrowe Park Hospital, Wirral University Hospital NHS Trust No financial interests Introduction • Cataract surgery in patients with myopia and hypermetropia can be technically challenging . • These challenges arise due to extremes of axial length which can lead to complications during biometry. • This can lead to potential intra and postoperative complications particularly with postoperative surprises particularly anisometropia. • Hence obtaining accurate biometry in these patients is essential to ensure that the cataract surgery is successful. Methods • Retrospective review of medisoft database was undertaken of cataract surgery carried out between Jan 2005 - September 2009 • Surgery was carried out by Consultants, Fellow and Registrars. • Myopia is defined when patient has an axial length more than 26mm • Hypermetropia is defined when patient has an axial length less than 22mm • Preoperative refraction, biometry measurements , visual acuity pre and post cataract surgery were all documented. • Deviation from - predicted postoperative outcome and - final best corrected visual acuity were recorded Results Axial length < 22mm Axial length >26mm Number of Patients 632 245 Number of Operations 764 297 Data Available 585 225 Mean Age of Patient 76.3 68.5 Age Range 37-95 13-93 Mean Post Op Spherical Equivalent -0.01+/-1.20 (SD) (95%CI +/- 0.11) -0.70 +/-0.95(SD) (95% CI +/-0.12) Mean Deviation From Predicted Refraction -0.01+/- 0.90 (SD) (95% CI +/- 0.08) -0.09+/- 1.34 (SD) (95% CI +/- 0.17) Predicted Post Operative Refraction +/1 D of predicted 484 192 <-1D of predicted 54 20 >1D of predicted 45 12 Axial Length <22mm Percentage of Patients 50 40 30 20 10 0 <-5 --4 -3 -2 -1 1 2 3 Deviation From Predicted Post-Operative Refraction 4 Axial Length>26mm Percentage of Patients 50 40 30 20 10 0 -5 -4 -3 -2 -1 1 2 3 4 5 >5 Deviation from predicted postoperative refraction Percentage of Patients Axial Length 22-26mm 50 45 40 35 30 25 20 15 10 5 0 -5 -4 -3 -2 -1 1 2 3 Deviation from predicted postoperative refraction 4 Main IOL Models Inserted IOL Mode (%) Axial Length <22mm Axial Length 2226mm Axial Length >26mm B&L L161AO 50.95 47.88 48.55 B&L L161SE 30.13 27.99 26.97 Chiron soflex 2 14.67 21.2 19.5 B&L M160 1.74 1.83 1.24 Conclusions • Postoperative refraction in the <22mm and >26mm groups was within +/-1D in 84% and 86 % respectively • There was no statistically significant difference between the mean post operative spherical equivalent -0.01 (<22mm) and 0.70 (>26mm). Paired Student t Test >0.05 • There was no statistically significant difference between the mean deviation from predicted refraction -0.01 (<22mm) and -0.09 (>26mm). Paired student t Test >0.05 Conclusions • 89.5% cases with Axial Lengths 22-26mm had a postoperative refraction of +/- 1D • Some postoperative surprises were noted as a result of Biometry errors which was rectified later with further surgery. • It may be wise to discuss this finding preoperatively when dealing with patients with extremes of axial length Available Evidence • Zuberbuhler et al state that 53.2% of patients were +/- 1D of predicted in those with axial lengths above 30mm • Lyle et al studied 106 highly myopic eyes. Postoperative corrected visual acuity was 20/40 or better in 94% of eyes, and uncorrected visual acuity was 20/40 or better in 77% of eyes at 27 months in those with axial lengths >26mm • Maclaren et al state 55% patients were +/- 1D of predcited in 76 eyes requiring IOLs between 30-35D References • 1. Zuberbuhler B, Seyedian M, Tuft S. Phacoemulsification in eyes with extreme axial myopia. J Cataract Refract Surg. 2009 Feb;35(2):335-40. • 2. Lyle et al. Phacoemulsification with intraocular lens implantation in high myopia. J Cataract Refract Surg. 1996 Mar;22(2):238-42. • 3. MacLaren RE et al. Biometry and formula accuracy with intraocular lenses used for cataract surgery in extreme hyperopia. Am J Ophthalmol. 2007 Jun;143(6):920-931.