Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in short eyes

Purpose: To compare the accuracy of preoperative biometry-based formulas to intraoperative aberrometry (IA) with respect to predicting refractive outcomes after cataract surgery in short eyes. Setting: Private practice and community-based ambulatory surgery center. Design: Retrospective consecutive case series. Methods: Eyes with an axial length (AL) shorter than 22.1 mm underwent cataract extraction and intraocular lens (IOL) implantation. The predicted residual refractive error was calculated preoperatively using Hoffer Q, Holladay 2, Haigis, Barrett Universal II, and Hill-RBF formulas and intraoperatively using IA. The postoperative spherical equivalent (SE) was compared with the predicted SE to evaluate the accuracy of each aforementioned method. Results: Fifty-one eyes from 38 patients met criteria to be included in the analysis. Without optimizing the formulas specifically for short eyes, the mean numerical errors (MNEs) associated with Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, and IA were -0.08 (95% confidence interval [CI], -0.30 to 0.13), -0.14 (95% CI, -0.35 to 0.07), +0.26 (95% CI, 0.05 to 0.47), +0.11 (95% CI, -0.10 to 0.32), +0.07 (95% CI, -0.14 to 0.28), and +0.00 (95% CI, -0.21 to 0.21), respectively (P <.001). The proportion of eyes within +/-0.5 diopter (D) of the predicted SE were 49.0%, 43.1%, 52.9%, 52.9%, 60.8%, and 58.8%, respectively (P =.06). The prediction outcomes from IA were statistically better than Haigis, but not other formulas. When formula and IA predictions differed by 0.5 D or more, IA's ability to recommend a more emmetropic outcome was no better than chance (50%). Conclusions: Intraoperative aberrometry is not significantly different from the best preoperative biometry-based methods available for IOL power selection in short eyes. (C) 2018 ASCRS and ESCRS