Axial length shows significant correlation with prediction error in scleral-fixated IOLs
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FRANKFURT, Germany — The four-flanged technique for scleral IOL fixation yields good outcomes but still not as good as in-the-bag implantation.
At the ESCRS winter meeting, Markus Schranz, MD, presented a study evaluating the refractive outcomes and biometric factors potentially leading to prediction error (PE) with different IOL power calculation formulae.
The study included 28 eyes of 28 patients implanted with the Micropure IOL (BVI). Average induced astigmatism was 1 D at 3 months, and 80% of patients were within 1 D of intended correction, with similar outcomes and a tendency for hyperopic PE with all formulae.
Axial length (AL) emerged as the most prominent factor for prediction error.
“With increasing AL, we see a decrease in refractive PE. Shorter eyes are more hyperopic than intended; longer eyes tend to be more myopic,” Schranz said.
This is due to a steady effective lens position, while the IOL-macula distance is changing with AL, he said.
Searching for landmarks, such as the scleral spur, that are visible on anterior segment OCT and under the surgical microscope could be one possible step to improve refractive outcomes.
“A better understanding of the correlations between AS-OCT and anatomical landmarks might improve IOL power calculation in the future because those patients get more and more demanding, and they want to have the same refraction after the surgeries as they had before,” he said.
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Schranz M. Refractive outcome, lens power calculation and surgical induced astigmatism after 4 flanged intrascleral intraocular lens fixation. Presented at: ESCRS winter meeting; Feb. 15-18, 2024; Frankfurt, Germany.
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