Pearl Dgs Second Eye Enhancement Significantly Improves Second-Eye Refractive Accuracy In Bilateral Cataract Surgery

To determine whether Pearl DGS Second Eye Enhancement (PD-SEE), incorporating first-eye postoperative spherical equivalent (SEQ), improves second-eye refractive prediction accuracy in bilateral cataract surgery.

Juntendo University Urayasu Hospital, Japan.

Consecutive patients undergoing bilateral cataract surgery between January 2023 and January 2025 with bilateral implantation of the XY1 IOL (HOYA) were retrospectively analyzed. Refractive prediction error was defined as postoperative SEQ minus predicted SEQ. PD-SEE calculations were generated using first-eye postoperative SEQ measured at postoperative day 1, week 1, and month 1 (1-day, 1-week, and 1-month PD-SEE). Second-eye refractive outcomes at 1 month were compared between Pearl DGS alone and each PD-SEE method using Eyetemis.

Fifty-two patients (104 eyes) were included (mean age 76.4 ± 6.7 years). Mean refractive prediction error with Pearl DGS was 0.33 ± 0.56 D, compared with –0.04 ± 0.55 D, 0.02 ± 0.56 D, and 0.04 ± 0.48 D using 1-day, 1-week, and 1-month PD-SEE, respectively (all p < 0.01). Mean absolute prediction error decreased from 0.53 ± 0.37 D with Pearl DGS to 0.43 ± 0.34 D (1-day), 0.44 ± 0.34 D (1-week), and 0.38 ± 0.30 D (1-month). Absolute errors were significantly lower with 1-week and 1-month PD-SEE compared with Pearl DGS (p = 0.04 and p < 0.01, respectively).

Pearl DGS Second Eye Enhancement significantly improved second-eye refractive accuracy in bilateral cataract surgery. Incorporating first-eye postoperative refraction, particularly at postoperative week 1 or month 1, reduced both systematic prediction error and absolute refractive error. PD-SEE may represent a practical strategy to optimize second-eye IOL power calculation.