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C. R. Henry, D. J. Covert, S. B. Koenig; Intraocular Lens Power Selection in the Second Eye of Patients Undergoing Bilateral, Sequential Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1150.
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To determine if one-month postoperative error of predicted refraction of the first eye can be used to alter intraocular lens (IOL) power selection and improve refractive results for the second eye in patients undergoing bilateral, sequential phacoemulsification with intraocular lens implantation (phaco/IOL).
Retrospective review of patients who underwent uncomplicated bilateral, sequential phacoemulsification with posterior chamber IOL between 1/1/2006 and 12/31/2007 by a single surgeon using a single IOL platform. The observed second eye one-month postoperative spherical equivalent refractive error was compared to calculations of the hypothetical one-month postoperative spherical equivalent refractive error if the first eye error had been fully or partially incorporated into the choice of IOL power for the second eye. The amount of partial adjustment was mathematically optimized.
206 patients met inclusion criteria. The average of the absolute value of the unadjusted second eye error (|EUNADJ|) was +0.44 diopters (D) compared to the fully adjusted second eye error (|EFULL| ), +0.42 D. The optimal amount of adjustment of the second eye IOL power was determined to be 50%; the average of the absolute value of this partially adjusted second eye error (|EPARTIAL,50%|) was +0.36 D_this was statistically different from |EUNADJ| (p<0.0001) and |EFULL| (p=0.001). The statistically significant benefit was observed for patients with either myopic or hyperopic errors in the first eye. The percentage of patients achieving postoperative refractions within 0.5 D or 1.0 D of the predicted refraction were 66.5% and 90.3% for the uncorrected second eye, 67.0% and 90.8% for the hypothetical fully corrected second eye, and 74.3% and 93.7% for the hypothetical partially corrected (50%) second eye.
Adjusting the IOL power in the second eye by 50% of the observed error of predicted refraction in the first eye reduced the error of predicted refraction in the second eye; this novel methodology has the potential to further improve the refractive outcomes in the second eye of cataract patients.
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