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Kristin Ow Chapman, Christopher E Starr, Kelley Bohm, Nathan M Radcliffe; Post Operative Refractive Outcomes in Patients Undergoing Combined Cataract Extraction, Endocyclophotocoagulation and iStent Placement (ICE Procedure). Invest. Ophthalmol. Vis. Sci. 2014;55(13):6121.
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To evaluate the postoperative visual acuity and refractive outcomes in patients with senile cataracts and mild to moderate glaucoma undergoing a triple procedure of combined iStent (Glaukos, CA) placement, cataract extraction with intraocular lens placement, and endocyclophotocoagulation (ECP) (ICE procedure).
A retrospective chart review was performed of 13 eyes of 12 patients with senile cataracts and mild to moderate glaucoma who underwent uncomplicated ICE procedure with in-the-bag monofocal IOL placement. Preoperative data included manifest or auto-refraction, IOLMaster (Carl Zeiss, Germany) biometry, and the spherical equivalent (SE) target as predicted by the selected IOL. Auto-refraction and/or manifest refraction were used postoperatively to measure refractive error at a minimum of 1 month follow-up. Descriptive statistics and paired t-tests were employed for statistical evaluation.
The average patient age was 71 years ± 6.5 with a range of 62 to 85 years. 61.5% (n=8) were female, and 53.8% (n=7) of the procedures were performed on the right eye. Average follow-up time was 78 days ± 46.2 (range 29-171 days). The postoperative refractive target for 76.9% (n=10) of the patients was distance vision (closest to plano SE) and 3 patients were targeted for intermediate vision (-1.00 to -1.50D SE). There was a significant improvement in best-corrected visual acuity (BCVA) following the procedure (p=0.02). The average preoperative BCVA was 20/30- and the average postoperative BCVA was 20/25+ with 92.3% percent of the patients achieving 20/30 or better. 38.5% of patients achieved an uncorrected visual acuity of 20/30 or better. Both pre- and postoperative subjective and objective measurements of refractive error were compared. There was no statistically significant difference between the preoperative targeted SE and postoperative manifest refraction SE (p=0.64) and autorefraction (p=0.40) at 1 month or later.
The combined ICE procedure, which includes ablating the ciliary processes, does not appear to alter the effective lens position or postoperative refractive predictability. In patients undergoing the ICE procedure a routine IOL selection process can be employed without the need for compensatory modifications.
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