Abstract
Purpose:
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).
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 567 intraocular lens •
677 refractive error development