Download - IOL Calculation Quanderies - Review of Ophthalmology

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Page 1: IOL Calculation Quanderies - Review of Ophthalmology

IOL Calculation Quandaries

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Case #1

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• PPLOV OU 10/2012:• OD -6.50 +1.00 x 170

20/30 (BAT 20/70)• OS -13.75 +0.50 x 170

20/40 (BAT 20/80)• Milky NSC OS > OD

(“Myopic cataracts”)

• 59-y/o ♂ w/ h/o:• RD OS s/p SB• Zoster keratitis/

trabeculitis s/p tube shunt OD

IOL Calcs - Lenstar• Axial length:

• OD 27.32 mm• OS 29.57 mm

• Auto-keratometry:• OD 42.29/43.00 @ 159

• Avg 42.64• OS 42.46/42.77 @ 139

• Avg 42.61

• IOL = SN60WF:• OD 11.0D → SE -0.43D• OS 5.0D → SE -0.41D 3

}Δ 2.25

IOL Calcs - IOLMaster• Axial length:

• OD 27.25 mm• OS 29.50 mm

• Auto-keratometry:• OD 42.29/43.21 @ 150

• Avg 42.75• OS 42.67/42.83 @ 173

• Avg 42.75

• IOL = SN60WF:• OD 11.0D → SE -0.47D• OS 5.0D → SE -0.45D 4

Are we good?

}Δ 2.25

Long Eyes• Standard calcs result in

hyperopic errors • Adjusted axial length:

• Holladay 1 formula• New axial lengths:

• OD 26.85 mm (from 27.25 mm)

• OS 28.72 mm (from 29.5 mm)

• IOL = SN60WF:• OD 12.0D → SE -0.34D• OS 6.5D → SE -0.17D 5

ALADJ = (0.8289 * ALIOLM) + 4.2663

Post-Op UCVA 20/20 OU

*Wang L, et al. J Cataract Refract Surg 2011; 37(11):2018-2027

Case #2

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• PPLOV & Monocular Diplopia OU 11/2012:• OD +1.25 +1.00 x 025

20/40- (BAT 20/70)• OS +1.00 +0.25 x 010

20/50 (BAT 20/80)• Nuclear & cortical

cataracts OU

• 68-y/o ♂ w/ Fuch’s s/p DSAEK OU:• OS 2005, OD 2006• Post-Op BCVA 20/20

OU

Page 2: IOL Calculation Quanderies - Review of Ophthalmology

IOL Calcs - Lenstar• Axial length:

• OD 24.02 mm

• OS 24.03 mm

• Auto-keratometry:• OD 41.56/42.68 @ 54

• Avg 42.12

• OS 42.08/43.16 @ 131

• Avg 42.62

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IOL Calcs - IOLMaster• Axial length:

• OD 23.99 mm

• OS 24.01 mm

• Auto-keratometry:• OD 41.67/42.72 @ 57

• Avg 42.20

• OS 42.03/43.27 @ 121

• Avg 42.65

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What about the DSAEK graft?

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Atlas Sim-K

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Atlas Sim-K

Galilei TCP

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Galilei TCP

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Page 3: IOL Calculation Quanderies - Review of Ophthalmology

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Optovue RTVue NCP

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Optovue RTVue NCP

IOL Calculations - Holladay 1

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Keratometry Avg K (D) IOL Power (D)SN60WF

Target Refraction (D)

Lenstar

IOLMaster

Galilei TCP

RTVue NCP

42.62 22.5 -1.20

42.65 22.5 -1.33

39.55 24.5 -0.18

41.56 22.5 -0.33

OS - First

Implanted IOL = SN60WF 22.5D: UCVA 20/20- (MR -0.50 +0.75 155 20/20+)

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IOL Calculations - Holladay 1

Keratometry Avg K (D) IOL Power (D)SN60WF

Target Refraction (D)

Lenstar

IOLMaster

Galilei TCP

RTVue NCP

42.12 23.5 -1.47

42.20 23.0 -1.27

39.69 24.5 -0.27

40.43 24.0 -0.43

OD - Second

Implanted IOL = SN60WF 24.0D (tight suture): BCVA 20/20 (-1.25 +1.75 x030, SE = -0.37)

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IOL Calculation Quandaries

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