Influence Of Preoperative Biometry And Intraoperative Aberrometry On Intraocular Lens Power Selection And Refractive Outcomes

To compare refractive outcomes of intraocular lens (IOL) sphere power selection based on intraoperative decision-making guided by preoperative biometry measured with Argos (Alcon) and calculated using the Barrett Universal II formula versus intraoperative aberrometry with Optiwave Refractive Analysis (ORA) in eyes without prior ocular surgery undergoing trifocal IOL implantation.

Arasanz Laser Vision, Buenos Aires, Argentina.

This retrospective study included eyes without prior ocular surgery implanted with toric (CNWTTx) or non-toric (CNWTT0) trifocal intraocular lenses during uncomplicated femtosecond laser–assisted cataract surgery (FLACS). 

Intraoperative decision-making for IOL sphere power selection was analyzed according to the influence of Optiwave Refractive Analysis (ORA) intraoperative aberrometry. Refractive prediction error (RPE) was calculated using the Barrett Universal II formula and ORA. Mean and median absolute RPE and the percentage of eyes within ±0.25, ±0.50, and ±0.75 diopters of target refraction were determined and stratified by IOL type. Correlations between postoperative spherical equivalent, UCVA, and BCVA were analyzed.

97 eyes were included. Mean and median absolute refractive prediction errors were 0.11D and 0.10D using preoperative Barrett II calculations and 0.08D and 0.08D using intraoperative aberrometry (ORA) (P > .05). Postoperative UCDVA was 0.05 logMAR in the Barrett II group and 0.02 logMAR in eyes with ORA-guided IOL power modification, while BCDVA was 0.00 logMAR in both groups. Postoperative refraction was ±0.25D in 40%, within ±0.50D in 96%, and within ±0.75D in 100% of eyes in the Barrett II and ORA groups (P > .05). ORA influenced IOL power selection in 11% of cases, confirmed the preoperative choice in 43%, and differed from it in 47%. In all modified cases, ORA-guided decisions resulted in superior refractive outcomes (P = .01)

In eyes without prior ocular surgery undergoing trifocal IOL implantation, intraoperative aberrometry with ORA plays a relevant role in IOL power decision-making. Although overall refractive accuracy was comparable between ORA and Barrett Universal II calculations, ORA-guided intraoperative modifications led to superior refractive outcomes when the implanted IOL differed from the preoperative plan. These findings support intraoperative aberrometry as a valuable adjunct to preoperative biometry for optimizing refractive outcomes in eyes with good visual potential.