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Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error after Phacovitrectomy
Journal Pre-proof The Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error after Phacovitrectomy: A Swept-source Anterior Segment OCT Analysis Nobuhiko Shiraki, MD, Taku Wakabayashi, MD, PhD, Hirokazu Sakaguchi, MD, PhD, Kohji Nishida, MD, PhD PII:
S0161-6420(19)32178-5
DOI:
https://doi.org/10.1016/j.ophtha.2019.10.021
Reference:
OPHTHA 10972
To appear in:
Ophthalmology
Received Date: 16 February 2019 Revised Date:
4 October 2019
Accepted Date: 17 October 2019
Please cite this article as: Shiraki N, Wakabayashi T, Sakaguchi H, Nishida K, The Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error after Phacovitrectomy: A Sweptsource Anterior Segment OCT Analysis, Ophthalmology (2019), doi: https://doi.org/10.1016/ j.ophtha.2019.10.021. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
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The Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error
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after Phacovitrectomy: A Swept-source Anterior Segment OCT Analysis
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Nobuhiko Shiraki, MD, Taku Wakabayashi, MD, PhD, Hirokazu Sakaguchi, MD, PhD,
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and Kohji Nishida, MD, PhD
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Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita,
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Osaka, Japan.
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Correspondence and reprint requests to Taku Wakabayashi, MD, PhD, Department of
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Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita,
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Osaka 565-0871, Japan. Tel: +81-06-6879-3456, Fax: +81-06-6879-3458, E-mail:
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[email protected]
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Financial disclosures: None.
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Conflict of Interest: No conflicting relationship exists for any author.
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Running head: Intraocular Lens Position and Refractive Error Analysis
1
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ABSTRACT
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Objective: To investigate the intraocular lens position and refractive outcomes
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following cataract surgery and phacovitrectomy using swept-source anterior segment
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optical coherence tomography (SS-ASOCT).
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Design: Retrospective case series
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Subjects: Patients underwent cataract surgery (Group A; 34 eyes), phacovitrectomy
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without gas tamponade (Group B; 20 eyes), and phacovitrectomy with gas tamponade
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(Group C; 22 eyes).
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Methods: Various parameters associated with the anterior chamber and lens were
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measured by SS-ASOCT (CASIA2®) before and after surgery. Axial lengths were
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measured by optical biometry (IOLMaster). The refraction (spherical equivalent) was
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measured 1 week and 1 month after surgery.
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Main Outcome Measures: Refractive outcomes and the parameters measured by
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SS-ASOCT were statistically evaluated.
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Results: The overall mean median absolute error (MedAE) was 0.34 D at 1 month
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postoperatively. The MedAE was greater in the Group C (0.47 D) than in the Group A
2
32
(0.31 D) and Group B (0.20 D). The overall mean refractive prediction error (ME) was
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0.22 ± 0.62 D at 1 month postoperatively. The ME was significantly greater in the
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Group C (-0.82 ± 0.64 D) than in the Group A (0.08 ± 0.39 D) and Group B (-0.07 ±
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0.45 D) (P<0.001, P<0.001), indicating a greater myopic shift in the Group C. The
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forward movement of the intraocular lens position was significantly correlated with a
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greater ME at 1 month (R=0.53, P<0.001).
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Conclusions: Forward fixation of the IOL caused myopic refractive errors even after
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the gas had disappeared in eyes that underwent phacovitrectomy with gas tamponade.
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Introduction
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Cataract surgery with phacoemulsification and intraocular lens (IOL) implantation
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through a small incision less than 2.4 mm has become the most prevalent surgery for
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elderly people with cataracts. Furthermore, with recent advances in small-incision
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cataract surgery and micro-incision vitrectomy surgery (MIVS), combined
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phacoemulsification, IOL implantation, and pars plana vitrectomy (PPV), known as
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phacovitrectomy, has become a widely performed surgical procedure in patients aged 50
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or older with vitreoretinal pathologies.1-5 Phacovitrectomy is recommended over
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vitrectomy alone because it ensures shorter surgery times with no concern for
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intraoperative lens contact or visually significant postoperative cataracts, and faster
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visual recovery. However, phacovitrectomy still has the disadvantage of postoperative
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refractive errors.6-9 Especially in eyes with rhegmatogenous retinal detachment (RRD),
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postoperative myopic shift may occur because of the potential errors in axial length
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(AL) measurement and forward movement of the IOL position due to gas
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tamponade.10,11 However, there has been no direct evidence of the correlation between
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the degree of forward IOL displacement and the myopic shift after phacovitrectomy
4
58
with gas tamponade. This is because conventional anterior segment optical coherence
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tomography (ASOCT) is limited in clearly depicting the position of the IOL
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postoperatively.
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A swept-source ASOCT instrument (SS-ASOCT) (CASIA2; Tomey Corp.,
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Nagoya, Japan), which provides 50,000 axial scans per second, offers tomographic
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images of the anterior segment with a width of 16 mm and a depth of 13 mm by
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utilizing a light wavelength of 1310 nm. Improved penetration enhances visualization of
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the anterior and posterior surface of the crystalline lens and IOL, as well as
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measurement of the aqueous depth (AQD) both before and after surgery.12
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In this study, we aimed to evaluate the anterior chamber and the location of
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the crystalline lens or IOL using SS-ASOCT before and after cataract surgery or
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phacovitrectomy, and examined their association with postoperative refractive
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outcomes.
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Patients and Methods
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The study was approved by the Ethics Committee of Osaka University Graduate School
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of Medicine (approval number 09297-4) and followed the tenets of the Declaration of
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Helsinki. We retrospectively conducted a chart review of consecutive patients who had
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undergone cataract surgery or phacovitrectomy between November 2016 and May 2017
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at Osaka University Hospital. After the initial review, the records for some eyes were
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excluded from data analysis because of the reasons described below: 1) sulcus fixation
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of IOL, intra-scleral IOL fixation, or sulcus suture of IOL due to intraoperative posterior
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capsule rupture; 2) corneal disease such as keratoconus; 3) Implantation of Toric or
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multifocal IOL; 4) previous history of intraocular surgery; 5) intraocular tamponade
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using silicon oil or octafluoropropane (C3F8); 6) scleral buckling combined vitrectomy;
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and 7) lack of preoperative examination of CASIA2.
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Preoperative examinations and intraocular lens calculation
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All patients underwent ophthalmologic examinations, including measurement of the
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best-corrected visual acuity (BCVA), refraction, indirect ophthalmoscopy,
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biomicroscopy of the anterior and posterior segments, fundus photograph,
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spectral-domain optical coherence tomography (OCT) (Cirrus HD-OCT 500; Carl Zeiss
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Meditec Inc., Dublin, CA), and SS-ASOCT (CASIA2). AL defined as the distance from
6
90
the tear film to the retinal pigment epithelium was measured in all eyes by optical
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biometry (IOLMaster 500, software version 7.5.3.0084) (Carl Zeiss, Oberkochen,
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Germany). The IOL power was calculated using the Barrett formula using the American
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Society of Cataract and Refractive Surgery (ASCRS) website. Lens constant
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recommended by the lens manufacturers was used for IOL calculation.
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CASIA2
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The anterior segment parameters were measured and defined with SS-ASOCT.
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Angle-to-angle width (ATA width), Anterior chamber width (ACW), Angle-to-angle
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depth (ATA depth), AQD, central corneal thickness (CCT), and lens thickness was
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defined and automatically measured with CASIA2 (software version 3E.26).
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Surgical procedure
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Cataract surgery was performed with phacoemulsification through a 2.2-mm or 2.4-mm
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clear corneal incision with CENTURION® (Alcon Laboratories, Inc., Fort Worth, TX).
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IOL was implanted into the capsular bag. Phacovitrectomy was performed in eyes with
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epiretinal membrane (ERM), macular hole (MH), and RRD. Phacoemulsification was
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conducted through a 2.2-mm or 2.4-mm clear corneal incision followed by a 25-gauge
7
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pars plana vitrectomy (PPV) with the CONSTELLATION® Vision System (Alcon
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Laboratories, Inc.). During PPV, the RESIGHT™ Fundus Viewing System (Carl Zeiss
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Meditec Inc.) was used. Core vitrectomy, mid peripheral vitrectomy, and vitreous base
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shaving under scleral depression was performed to remove the vitreous.
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Perfluorocarbon liquid (PFCL) (Perfluoron; Alcon Laboratories, Inc.) was used in some
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cases depending on the retinal detachment extent. The IOL was implanted into the
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capsular bag. In cases with MH and RRD, fluid–air exchange was performed. Endolaser
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photocoagulation was performed around the area of retinal breaks, and the vitreous
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cavity was replaced by a 20% sulfur hexafluoride. Patients who underwent gas
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tamponade were instructed to remain face down for 2 to 7 days.
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Postoperative examinations
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The refraction and parameters of CASIA2 were measured at 1 week and at 1 month
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after surgery. The achieved postoperative refraction was expressed as a sphere
119
equivalent. The postoperative AQD was defined as the distance between the anterior
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IOL surface and the posterior corneal surface. The AQD was measured and calculated
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automatically with CASIA2, as was the tilt of IOL and decentration. The IOL position
8
122
was calculated by dividing the change of AQD, which is the preoperative AQD
123
subtracted from the postoperative AQD, by the lens thickness.
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Data Collection and Statistical Analyses
125
The following data were collected: ophthalmic history, pre- and postoperative BCVA,
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pre- and postoperative refraction, ACW, AQD, CCT, and lens thickness. The mean
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refractive prediction error (ME) (i.e., the postoperative actual refraction minus
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preoperative refraction predicted by the formula for the exact power of the implanted
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IOL) was calculated. The median absolute error (MedAE) was calculated after ME is
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made equal to zero as previously described 13 The main outcome measures were the
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associations between CASIA2 parameters and the refractive outcomes.
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Statistical analysis was performed using JMP® Version 13.0.0 Statistical
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Software (SAS Institute Inc., Cary, NC). Continuous values are expressed as mean ±
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standard deviation (SD). The BCVA of each patient was converted to its logarithm of
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the minimal angle of resolution (logMAR) value for calculations. A P-value of less than
136
0.05 was considered statistically significant.
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Results
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Seventy-six eyes of 76 consecutive patients were reviewed. We divided the 76 eyes into
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three groups for analysis. The Group A included 34 eyes of 34 patients that underwent
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cataract surgery, the Group B included 20 eyes of 20 patients with ERM that underwent
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phacovitrectomy without gas tamponade, and the Group C included 22 eyes (MH; 8
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eyes and RRD; 14 eyes [macula-on: 11 eyes, macula-off: 3 eyes]) of 22 patients that
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underwent phacovitrectomy with gas tamponade. Patient characteristics are summarized
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in Table 1. Overall, the mean age of the patients was 69.6 ± 9.5 years (range, 42 to 86
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years). The mean axial length measured was 24.13 ± 1.36 mm. The mean preoperative
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BCVA (logMAR) was 0.38 ± 0.55. The mean BCVA significantly improved to 0.13 ±
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0.32 at 1 month (P<0.001).
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Refractive outcomes
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The mean predicted refraction before surgery was -0.70 ± 1.00 D. The achieved
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postoperative refraction was -1.00 ± 1.34 D at 1 week and -0.91 ± 1.19 D at 1 month
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postoperatively. The MedAE was 0.36 at 1 week and 0.34 at 1 month postoperatively.
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The ME was -0.30 ± 0.87 D at 1 week and -0.22 ± 0.62 D at 1 month postoperatively.
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Postoperative refractive data are summarized in Table 2. In Group A, The
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MedAE was 0.32 D at 1 week and 0.31 D at 1 month postoperatively. The ME was
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-0.05 ± 0.87 D at 1 week and 0.08 ± 0.39 D at 1 month postoperatively. In Group B, the
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MedAE was 0.27 D at 1 week and 0.20 D at 1 month postoperatively. The ME was
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-0.26 ± 0.93 D at 1 week and -0.07 ± 0.45 D at 1 month postoperatively. In Group C, the
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MedAE was 0.38 D at 1 week and 0.47 D at 1 month postoperatively. The ME was
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-0.73 ± 0.65 D at 1 week and -0.82 ± 0.64 D at 1 month postoperatively. Therefore, the
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MedAE was greater in Group C compared with those in other two groups at 1 week and
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1 month. In addition, the ME was also significantly greater in Group C, compared with
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those in other two groups at 1 week and 1 month (P<0.001, P<0.001), indicating greater
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myopic shift in patients with vitrectomy with gas tamponade.
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Preoperative factors associated with postoperative refractive error
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Among the 76 studied eyes, univariate analysis revealed that the presence of gas
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tamponade, preoperative AQD, and lens thickness were significant preoperative factors
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associated with the postoperative ME at 1 month (R=0.60, P<0.001; R=0.31, P=0.006;
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and R=0.27, P=0.02, respectively). Age, gender, laterality of the eye, preoperative
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BCVA, axial length, ACW, and target refraction were not associated with postoperative
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ME at 1 month. In the multivariate regression analysis, the presence of gas tamponade
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was only the preoperative factor significantly associated with postoperative ME at 1
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month (P<0.001). Among 22 eyes with gas tamponade, the ME was not significantly
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different between eyes with MH and RRD (P=0.84). The ME was also not significantly
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different between macula-on and macula-off RRD (P=0.67).
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Postoperative aqueous depth
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There was no significant difference of the mean preoperative AQD in three groups
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(P=0.1) (Table 1). The mean postoperative AQD was 4.17 ± 0.35 at 1week and 4.21 ±
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0.3 at 1 month. In Group A, the AQD was 4.28 ± 0.32 D at 1 week and 4.21 ± 0.3 D at 1
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month postoperatively. In Group B, the AQD was 4.23 ± 0.3 D at 1 week and 4.30 ±
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0.26 D at 1 month postoperatively. In Group C, the AQD was 3.95 ± 0.33D at 1 week
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and 4.09 ± 0.21D at 1 month postoperatively. Therefore, the AQD was significantly
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shallower in Group C, compared with those in other two groups (P<.001 at 1 week,
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P=0.02 at 1month), indicating shallower AQD in patients with vitrectomy with gas
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tamponade even after gas resolution (Figure 1). The changes in the AQD was also
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significantly less at 1 week (P<.001) and at 1 month (P<.001) in patients with Group C
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(Table 3).
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Postoperative IOL status
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The mean IOL position was 0.31 ± 0.12 at 1 week and 0.32 ± 0.11 at 1 month. In Group
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A, the IOL position was 0.36 ± 0.05 at 1 week and 0.35 ± 0.05 at 1 month. In Group B,
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the IOL position was 0.31 ± 0.11 at 1 week and 0.32 ± 0.11 at 1 month. In Group C, the
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IOL position was 0.22 ± 0.16 at 1 week and 0.25 ± 0.15 at 1 month. The IOL position
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moved significantly forward in Group C, compared with those in other two groups
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(P<0.001 at 1 week, P<0.001 at 1 month). The degree of IOL tilt was significantly larger
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in Group C than those in the other two groups, but only at 1 week (P=0.004) (Table 3).
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There was no significant difference of IOL decentration in three groups (P=0.08) (Table
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3).
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The relationship between IOL status and postoperative refractive error
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The forward movement of the IOL position was significantly correlated with greater
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ME at 1 month (R=0.53, P<.0001).
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Relationship among ACW and postoperative values
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Preoperative ACW was not significantly correlated with postoperative AQD (P=0.12).
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There was no significant relationship between preoperative ACW and ME at 1 month
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(P=0.32).
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Discussion
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In this study, we compared the refractive outcomes and SS-ASOCT parameters in three
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groups, i.e. the “cataract surgery group (Group A)”, “vitrectomy without gas tamponade
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group (Group B)”, and “vitrectomy with gas tamponade group (Group C)”. The reason
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for these classifications was to evaluate the influence of gas tamponade and vitrectomy
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on the lens position and refractive outcomes.
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The difference between predicted and achieved refraction was not
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significantly different at 1 week and at 1 month postoperatively in both the “cataract
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surgery” group and “vitrectomy without gas tamponade” group. Danjo et al. reported
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that the reason of the myopic shift after vitrectomy was associated with the replacement
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of vitreous with aqueous humor with a lower refractive index and the change in the
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AQD.14 However, in this study, the position of IOL was not significantly different at 1
14
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month postoperatively between the “cataract surgery” and “vitrectomy without gas
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tamponade” groups, indicating that simple vitrectomy does not have a significant
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influence on postoperative refractive errors and position of the IOL.
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A greater myopic shift was observed postoperatively in the “vitrectomy with
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gas tamponade” group compared with that in the other two groups, as reported
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previously.15 In the multivariate regression analysis, the presence of gas tamponade was
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the only factor significantly associated with myopic shift at 1 month. Myopic shift after
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vitrectomy with gas tamponade has been reported to be associated with forward
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movement of the IOL caused by buoyancy and surface tension of the gas. In this study,
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the postoperative AQD at 1 month was significantly shallower in the “vitrectomy with
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gas tamponade” group, compared with that in the other two groups. In addition, the
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postoperative AQD was shallower at 1 week than at 1month postoperatively in the
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“vitrectomy with gas tamponade” group. This is because the buoyancy and surface
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tension of the gas pushed the IOL after the vitrectomy with gas tamponade procedure,
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even if the patients maintained a strict prone position. This resulted in the position of
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the IOL being fixed in a forward position in the “vitrectomy with gas tamponade” group,
15
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even after the gas disappeared after 1 month postoperatively. It was notable that the
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forward IOL position significantly correlated with the myopic shift postoperatively in
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the current study. In contrast to the forward movement of the IOL, the tilt of the IOL
237
became similar to the tilt after cataract surgery at 1 month, although the tilt was
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significantly greater at 1 week in eyes that underwent vitrectomy with gas tamponade.
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In summary, the current study confirmed that the gas pushes the IOL forward
240
for at least 1 week after vitrectomy, resulting in tilt and forward movement of the IOL
241
and a shallow AQD. As the gas spontaneously decreases over time, the pushing power
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of the gas weakens, resulting in backward movement of the IOL, a deeper AQD, and
243
normalization of the IOL tilt. However, the IOL does not return to the same position as
244
in eyes following cataract surgery and vitrectomy without gas tamponade. Consequently,
245
the postoperative AQD was shallower compared to that in cases after cataract surgery,16
246
and the IOL was fixed in a forward position even after gas resolution, leading to the
247
postoperative myopic shift.
248
This study has several limitations, including its retrospective design, a relatively
249
small sample size, and a short study period. Minor differences in the extent of vitreous
16
250
base shaving in each patients may have potentially influenced the zonular laxity
251
affecting the position of the IOL. Therefore, further studies with a larger number of
252
patients are necessary to validate the current results and to improve understanding of
253
IOL position and refractive outcomes in cataract surgery and vitrectomy with gas
254
tamponade. Nevertheless, the current study reveals that forward movement of the IOL
255
correlated with the myopic shift in eyes that underwent vitrectomy with gas tamponade
256
based on SS-ASOCT measurements. Our findings are valuable for improving our
257
understanding of the IOL position after surgery and to help prevent refractive error in
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eyes treated with phacovitrectomy.
17
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References
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3. Scharwey K, Pavlovic S, Jacobi KW. Combined clear corneal phacoemulsification,
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4. Koenig SB, Han DP, Mieler WF, et al. Combined phacoemulsification and pars plana vitrectomy. Arch Ophthalmol. 1990;108:362–364.
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5. Demetriades A-M, Gottsch JD, Thomsen R, et al. Combined phacoemulsification,
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intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and
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vitreoretinal pathology. Am J Ophthalmol. 2003;135:291–296.
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6. Vounotrypidis E, Haralanova V, Muth DR, et al. Accuracy of SS-OCT biometry
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phacovitrectomy with internal limiting membrane peeling. J Cataract Refract Surg.
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Vitrectomy for Epiretinal Membrane. Retina. 2018 [Epub ahead of print]
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8. Hötte GJ, de Bruyn DP, de Hoog J. Post-operative Refractive Prediction Error After Phacovitrectomy: A Retrospective Study. Ophthalmol Ther. 2018;7:83-94. 18
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9. Kang EC, Lee KH, Koh HJ. Comparison of refractive error in phacovitrectomy for
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epiretinal membrane using ultrasound and partial coherence interferometry. Eur J
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10. Rahman R, Bong CX, Stephenson J. Accuracy of intraocular lens power estimation
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in eyes having phacovitrectomy for rhegmatogenous retinal detachment. Retina.
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2014;34:1415–1420.
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11. Shiraki N, Wakabayashi T, Sakaguchi H, Nishida K. Optical Biometry-Based
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Intraocular Lens Calculation and Refractive Outcomes after Phacovitrectomy for
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Rhegmatogenous Retinal Detachment and Epiretinal Membrane. Sci Rep. 2018
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27;8:11319.
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12. Sato T, Shibata S, Yoshida M, Hayashi K. Short-term Dynamics after Single- and
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Three-piece Acrylic Intraocular Lens Implantation: A Swept-source Anterior
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Segment Optical Coherence Tomography Study. Sci Rep. 2018;8:10230.
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13. Hoffer KJ, Aramberri J, Haigis W, et al. Protocols for studies of intraocular lens formula accuracy. Am J Ophthalmol. 2015;160:1086-7.
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14. Danjo Y, Mitsuda H, Maeno T. Cataract surgery for avitreous eyes-postoperative refractive prediction error. Folia Ophthalmol Jpn. 1993;44:1243–1247.
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15. Patel D, Rahman R, Kumarasamy M. Accuracy of intraocular lens power estimation
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in eyes having phacovitrectomy for macular holes. J Cataract Refract Surg.
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2007;33:1760–1762.
318 319 320
16. Hoffer KJ, Savini G. Anterior chamber depth studies. J Cataract Refract Surg. 2015;41:1898-904.
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Figure legend
323 324
Figure 1. Parameters of swept-source anterior segment optical coherence tomography
325
after cataract surgery and phacovitrectomy. (A) Aqueous depth (AQD) and relative IOL
326
position 1 month after cataract surgery (Group A). AQD is 4.25 ± 0.35 mm. Position of
327
the IOL (0.36) was calculated assuming that the original lens thickness was 1. (B) AQD
328
and IOL position 1 month after phacovitrectomy without gas tamponade (Group B).
329
AQD is 4.30 ± 0.26 mm. Position of the IOL was 0.32. (C) AQD and IOL position 1
330
week after phacovitrectomy with gas tamponade (Group C). AQD is 3.95 ± 0.33 mm.
331
Position of the IOL was 0.22. (D) AQD and IOL position 1 month after
332
phacovitrectomy with gas tamponade (Group C). AQD is 4.09 ± 0.21 mm. Position of
333
the IOL was 0.25.
334 335 336
20
Table 1. Patient characteristics Overall
Group A
Group B
Group C
P value
20/20 22/22 34/34 No. of eyes/No. of patients 76/76 0.001 68.6±11.2 64.8±8.1 69.6±9.5 73.8±7.5 Age (yrs) (mean ± SD) 9 (41) 0.3 20 (59) 12 (60) Gender, no. of women (%) 41 (54) 0.9 10 (45) 40 (53) 17 (50) 11 (55) Eye, no. of right eyes (%) 0.53±0.56 0.03 0.53±0.75 Preoperative BCVA, LogMAR (mean ± SD) 0.38±0.55 0.21±0.32 24.16±1.38 24.13±1.37 0.9 24.12±1.4 Axial length (mm) 24.13±1.36 0.1 2.55±0.45 2.80±0.52 2.92±0.70 2.73±0.57 Aqueous depth (AQD) (mm) (mean ± SD) 0.4 11.57±0.42 11.67±0.41 11.74±0.35 11.69±0.48 Anterior chamber width (ACW) (mm) (mean ± SD) 541.73±32.10 0.76 Central corneal thickness (CCT) (mm) (mean ± SD) 541.70±26.20 539.62±24.53 545.25±22.50 4.71±0.40 4.54±0.52 4.34±0.54 0.03 Lens Thickness (mm) (mean ± SD) 4.56±0.49 BCVA; best-corrected visual acuity, logMAR; logarithm of the minimum angle of resolution, SD; standard deviation. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Table 2. Refractive outcomes Overall
Group A
Group B
Group C
P value
MedAE at 1 week 0.36 0.32 0.27 0.38 ME at 1 week (mean ± SD) -0.30 ± 0.87 0.05 ± 0.87 -0.26 ± 0.93 -0.73 ± 0.65 <.001 MedAE at 1 month 0.34 0.31 0.20 0.47 ME at 1 month (mean ± SD) -0.22 ± 0.62 0.08 ± 0.39 -0.07 ± 0.45 -0.82 ± 0.64D <.001 ME; mean refractive prediction error. MedAE; median absolute error. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Table 3. Postoperative parameters of swept-source anterior segment optical coherence tomography Overall
Group A
Group B
Group C
P value
1 week postoperatively Aqueous depth (AQD) (mm) (mean ± SD) 4.17±0.35 4.28±0.32 4.23±0.3 3.95±0.33 <.001 Changes in AQD (mm) (mean ± SD) 1.44±0.56 1.73±0.33 1.43±0.51 1.03±0.62 <.001 IOL position (mm) (mean ± SD) 0.31±0.12 0.36±0.05 0.31±0.11 0.22±0.16 <.001 IOL tilt (mm) (mean ± SD) 4.79±2.29 3.89±2.06 5.12±1.86 5.86±2.50 0.004 IOL decentration (mm) (mean ± SD) 0.35±0.28 0.33±0.26 0.44±0.38 0.29±0.19 0.5 1 month postoperatively Aqueous depth (AQD) (mm) (mean ± SD) 4.21±0.3 4.25±0.35 4.30±0.26 4.09±0.21 0.02 Changes in AQD (mm) (mean ± SD) 1.48±0.51 1.70±0.31 1.50±0.50 1.17±0.62 <.001 IOL position (mm) (mean ± SD) 0.32±0.11 0.36±0.05 0.32±0.11 0.25±0.15 <.001 IOL tilt (mm) (mean ± SD) 5.02±1.94 4.99±1.97 5.15±2.09 4.97±1.83 0.9 IOL decentration (mm) (mean ± SD) 0.38±0.31 0.31±0.25 0.39±0.29 0.48±0.39 0.08 IOL; intraocular lens, SD; standard deviation. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Highlights Swept-source anterior segment optical coherence tomography analysis identified that the forward movement of the intraocular lens position significantly correlated with a greater refractive error after phacovitrectomy with gas tamponade.
S0161-6420(19)32178-5
DOI:
https://doi.org/10.1016/j.ophtha.2019.10.021
Reference:
OPHTHA 10972
To appear in:
Ophthalmology
Received Date: 16 February 2019 Revised Date:
4 October 2019
Accepted Date: 17 October 2019
Please cite this article as: Shiraki N, Wakabayashi T, Sakaguchi H, Nishida K, The Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error after Phacovitrectomy: A Sweptsource Anterior Segment OCT Analysis, Ophthalmology (2019), doi: https://doi.org/10.1016/ j.ophtha.2019.10.021. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
1
The Effect of Gas Tamponade on the Intraocular Lens Position and Refractive Error
2
after Phacovitrectomy: A Swept-source Anterior Segment OCT Analysis
3
Nobuhiko Shiraki, MD, Taku Wakabayashi, MD, PhD, Hirokazu Sakaguchi, MD, PhD,
4
and Kohji Nishida, MD, PhD
5
6
Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita,
7
Osaka, Japan.
8
9
Correspondence and reprint requests to Taku Wakabayashi, MD, PhD, Department of
10
Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita,
11
Osaka 565-0871, Japan. Tel: +81-06-6879-3456, Fax: +81-06-6879-3458, E-mail:
12
[email protected]
13
Financial disclosures: None.
14
Conflict of Interest: No conflicting relationship exists for any author.
15
Running head: Intraocular Lens Position and Refractive Error Analysis
1
16
ABSTRACT
17
Objective: To investigate the intraocular lens position and refractive outcomes
18
following cataract surgery and phacovitrectomy using swept-source anterior segment
19
optical coherence tomography (SS-ASOCT).
20
Design: Retrospective case series
21
Subjects: Patients underwent cataract surgery (Group A; 34 eyes), phacovitrectomy
22
without gas tamponade (Group B; 20 eyes), and phacovitrectomy with gas tamponade
23
(Group C; 22 eyes).
24
Methods: Various parameters associated with the anterior chamber and lens were
25
measured by SS-ASOCT (CASIA2®) before and after surgery. Axial lengths were
26
measured by optical biometry (IOLMaster). The refraction (spherical equivalent) was
27
measured 1 week and 1 month after surgery.
28
Main Outcome Measures: Refractive outcomes and the parameters measured by
29
SS-ASOCT were statistically evaluated.
30
Results: The overall mean median absolute error (MedAE) was 0.34 D at 1 month
31
postoperatively. The MedAE was greater in the Group C (0.47 D) than in the Group A
2
32
(0.31 D) and Group B (0.20 D). The overall mean refractive prediction error (ME) was
33
0.22 ± 0.62 D at 1 month postoperatively. The ME was significantly greater in the
34
Group C (-0.82 ± 0.64 D) than in the Group A (0.08 ± 0.39 D) and Group B (-0.07 ±
35
0.45 D) (P<0.001, P<0.001), indicating a greater myopic shift in the Group C. The
36
forward movement of the intraocular lens position was significantly correlated with a
37
greater ME at 1 month (R=0.53, P<0.001).
38
Conclusions: Forward fixation of the IOL caused myopic refractive errors even after
39
the gas had disappeared in eyes that underwent phacovitrectomy with gas tamponade.
40
41
3
42
Introduction
43
Cataract surgery with phacoemulsification and intraocular lens (IOL) implantation
44
through a small incision less than 2.4 mm has become the most prevalent surgery for
45
elderly people with cataracts. Furthermore, with recent advances in small-incision
46
cataract surgery and micro-incision vitrectomy surgery (MIVS), combined
47
phacoemulsification, IOL implantation, and pars plana vitrectomy (PPV), known as
48
phacovitrectomy, has become a widely performed surgical procedure in patients aged 50
49
or older with vitreoretinal pathologies.1-5 Phacovitrectomy is recommended over
50
vitrectomy alone because it ensures shorter surgery times with no concern for
51
intraoperative lens contact or visually significant postoperative cataracts, and faster
52
visual recovery. However, phacovitrectomy still has the disadvantage of postoperative
53
refractive errors.6-9 Especially in eyes with rhegmatogenous retinal detachment (RRD),
54
postoperative myopic shift may occur because of the potential errors in axial length
55
(AL) measurement and forward movement of the IOL position due to gas
56
tamponade.10,11 However, there has been no direct evidence of the correlation between
57
the degree of forward IOL displacement and the myopic shift after phacovitrectomy
4
58
with gas tamponade. This is because conventional anterior segment optical coherence
59
tomography (ASOCT) is limited in clearly depicting the position of the IOL
60
postoperatively.
61
A swept-source ASOCT instrument (SS-ASOCT) (CASIA2; Tomey Corp.,
62
Nagoya, Japan), which provides 50,000 axial scans per second, offers tomographic
63
images of the anterior segment with a width of 16 mm and a depth of 13 mm by
64
utilizing a light wavelength of 1310 nm. Improved penetration enhances visualization of
65
the anterior and posterior surface of the crystalline lens and IOL, as well as
66
measurement of the aqueous depth (AQD) both before and after surgery.12
67
In this study, we aimed to evaluate the anterior chamber and the location of
68
the crystalline lens or IOL using SS-ASOCT before and after cataract surgery or
69
phacovitrectomy, and examined their association with postoperative refractive
70
outcomes.
71
72
Patients and Methods
73
The study was approved by the Ethics Committee of Osaka University Graduate School
5
74
of Medicine (approval number 09297-4) and followed the tenets of the Declaration of
75
Helsinki. We retrospectively conducted a chart review of consecutive patients who had
76
undergone cataract surgery or phacovitrectomy between November 2016 and May 2017
77
at Osaka University Hospital. After the initial review, the records for some eyes were
78
excluded from data analysis because of the reasons described below: 1) sulcus fixation
79
of IOL, intra-scleral IOL fixation, or sulcus suture of IOL due to intraoperative posterior
80
capsule rupture; 2) corneal disease such as keratoconus; 3) Implantation of Toric or
81
multifocal IOL; 4) previous history of intraocular surgery; 5) intraocular tamponade
82
using silicon oil or octafluoropropane (C3F8); 6) scleral buckling combined vitrectomy;
83
and 7) lack of preoperative examination of CASIA2.
84
Preoperative examinations and intraocular lens calculation
85
All patients underwent ophthalmologic examinations, including measurement of the
86
best-corrected visual acuity (BCVA), refraction, indirect ophthalmoscopy,
87
biomicroscopy of the anterior and posterior segments, fundus photograph,
88
spectral-domain optical coherence tomography (OCT) (Cirrus HD-OCT 500; Carl Zeiss
89
Meditec Inc., Dublin, CA), and SS-ASOCT (CASIA2). AL defined as the distance from
6
90
the tear film to the retinal pigment epithelium was measured in all eyes by optical
91
biometry (IOLMaster 500, software version 7.5.3.0084) (Carl Zeiss, Oberkochen,
92
Germany). The IOL power was calculated using the Barrett formula using the American
93
Society of Cataract and Refractive Surgery (ASCRS) website. Lens constant
94
recommended by the lens manufacturers was used for IOL calculation.
95
CASIA2
96
The anterior segment parameters were measured and defined with SS-ASOCT.
97
Angle-to-angle width (ATA width), Anterior chamber width (ACW), Angle-to-angle
98
depth (ATA depth), AQD, central corneal thickness (CCT), and lens thickness was
99
defined and automatically measured with CASIA2 (software version 3E.26).
100
Surgical procedure
101
Cataract surgery was performed with phacoemulsification through a 2.2-mm or 2.4-mm
102
clear corneal incision with CENTURION® (Alcon Laboratories, Inc., Fort Worth, TX).
103
IOL was implanted into the capsular bag. Phacovitrectomy was performed in eyes with
104
epiretinal membrane (ERM), macular hole (MH), and RRD. Phacoemulsification was
105
conducted through a 2.2-mm or 2.4-mm clear corneal incision followed by a 25-gauge
7
106
pars plana vitrectomy (PPV) with the CONSTELLATION® Vision System (Alcon
107
Laboratories, Inc.). During PPV, the RESIGHT™ Fundus Viewing System (Carl Zeiss
108
Meditec Inc.) was used. Core vitrectomy, mid peripheral vitrectomy, and vitreous base
109
shaving under scleral depression was performed to remove the vitreous.
110
Perfluorocarbon liquid (PFCL) (Perfluoron; Alcon Laboratories, Inc.) was used in some
111
cases depending on the retinal detachment extent. The IOL was implanted into the
112
capsular bag. In cases with MH and RRD, fluid–air exchange was performed. Endolaser
113
photocoagulation was performed around the area of retinal breaks, and the vitreous
114
cavity was replaced by a 20% sulfur hexafluoride. Patients who underwent gas
115
tamponade were instructed to remain face down for 2 to 7 days.
116
Postoperative examinations
117
The refraction and parameters of CASIA2 were measured at 1 week and at 1 month
118
after surgery. The achieved postoperative refraction was expressed as a sphere
119
equivalent. The postoperative AQD was defined as the distance between the anterior
120
IOL surface and the posterior corneal surface. The AQD was measured and calculated
121
automatically with CASIA2, as was the tilt of IOL and decentration. The IOL position
8
122
was calculated by dividing the change of AQD, which is the preoperative AQD
123
subtracted from the postoperative AQD, by the lens thickness.
124
Data Collection and Statistical Analyses
125
The following data were collected: ophthalmic history, pre- and postoperative BCVA,
126
pre- and postoperative refraction, ACW, AQD, CCT, and lens thickness. The mean
127
refractive prediction error (ME) (i.e., the postoperative actual refraction minus
128
preoperative refraction predicted by the formula for the exact power of the implanted
129
IOL) was calculated. The median absolute error (MedAE) was calculated after ME is
130
made equal to zero as previously described 13 The main outcome measures were the
131
associations between CASIA2 parameters and the refractive outcomes.
132
Statistical analysis was performed using JMP® Version 13.0.0 Statistical
133
Software (SAS Institute Inc., Cary, NC). Continuous values are expressed as mean ±
134
standard deviation (SD). The BCVA of each patient was converted to its logarithm of
135
the minimal angle of resolution (logMAR) value for calculations. A P-value of less than
136
0.05 was considered statistically significant.
137
9
138
Results
139
Seventy-six eyes of 76 consecutive patients were reviewed. We divided the 76 eyes into
140
three groups for analysis. The Group A included 34 eyes of 34 patients that underwent
141
cataract surgery, the Group B included 20 eyes of 20 patients with ERM that underwent
142
phacovitrectomy without gas tamponade, and the Group C included 22 eyes (MH; 8
143
eyes and RRD; 14 eyes [macula-on: 11 eyes, macula-off: 3 eyes]) of 22 patients that
144
underwent phacovitrectomy with gas tamponade. Patient characteristics are summarized
145
in Table 1. Overall, the mean age of the patients was 69.6 ± 9.5 years (range, 42 to 86
146
years). The mean axial length measured was 24.13 ± 1.36 mm. The mean preoperative
147
BCVA (logMAR) was 0.38 ± 0.55. The mean BCVA significantly improved to 0.13 ±
148
0.32 at 1 month (P<0.001).
149
Refractive outcomes
150
The mean predicted refraction before surgery was -0.70 ± 1.00 D. The achieved
151
postoperative refraction was -1.00 ± 1.34 D at 1 week and -0.91 ± 1.19 D at 1 month
152
postoperatively. The MedAE was 0.36 at 1 week and 0.34 at 1 month postoperatively.
153
The ME was -0.30 ± 0.87 D at 1 week and -0.22 ± 0.62 D at 1 month postoperatively.
10
154
Postoperative refractive data are summarized in Table 2. In Group A, The
155
MedAE was 0.32 D at 1 week and 0.31 D at 1 month postoperatively. The ME was
156
-0.05 ± 0.87 D at 1 week and 0.08 ± 0.39 D at 1 month postoperatively. In Group B, the
157
MedAE was 0.27 D at 1 week and 0.20 D at 1 month postoperatively. The ME was
158
-0.26 ± 0.93 D at 1 week and -0.07 ± 0.45 D at 1 month postoperatively. In Group C, the
159
MedAE was 0.38 D at 1 week and 0.47 D at 1 month postoperatively. The ME was
160
-0.73 ± 0.65 D at 1 week and -0.82 ± 0.64 D at 1 month postoperatively. Therefore, the
161
MedAE was greater in Group C compared with those in other two groups at 1 week and
162
1 month. In addition, the ME was also significantly greater in Group C, compared with
163
those in other two groups at 1 week and 1 month (P<0.001, P<0.001), indicating greater
164
myopic shift in patients with vitrectomy with gas tamponade.
165
Preoperative factors associated with postoperative refractive error
166
Among the 76 studied eyes, univariate analysis revealed that the presence of gas
167
tamponade, preoperative AQD, and lens thickness were significant preoperative factors
168
associated with the postoperative ME at 1 month (R=0.60, P<0.001; R=0.31, P=0.006;
169
and R=0.27, P=0.02, respectively). Age, gender, laterality of the eye, preoperative
11
170
BCVA, axial length, ACW, and target refraction were not associated with postoperative
171
ME at 1 month. In the multivariate regression analysis, the presence of gas tamponade
172
was only the preoperative factor significantly associated with postoperative ME at 1
173
month (P<0.001). Among 22 eyes with gas tamponade, the ME was not significantly
174
different between eyes with MH and RRD (P=0.84). The ME was also not significantly
175
different between macula-on and macula-off RRD (P=0.67).
176
Postoperative aqueous depth
177
There was no significant difference of the mean preoperative AQD in three groups
178
(P=0.1) (Table 1). The mean postoperative AQD was 4.17 ± 0.35 at 1week and 4.21 ±
179
0.3 at 1 month. In Group A, the AQD was 4.28 ± 0.32 D at 1 week and 4.21 ± 0.3 D at 1
180
month postoperatively. In Group B, the AQD was 4.23 ± 0.3 D at 1 week and 4.30 ±
181
0.26 D at 1 month postoperatively. In Group C, the AQD was 3.95 ± 0.33D at 1 week
182
and 4.09 ± 0.21D at 1 month postoperatively. Therefore, the AQD was significantly
183
shallower in Group C, compared with those in other two groups (P<.001 at 1 week,
184
P=0.02 at 1month), indicating shallower AQD in patients with vitrectomy with gas
185
tamponade even after gas resolution (Figure 1). The changes in the AQD was also
12
186
significantly less at 1 week (P<.001) and at 1 month (P<.001) in patients with Group C
187
(Table 3).
188
Postoperative IOL status
189
The mean IOL position was 0.31 ± 0.12 at 1 week and 0.32 ± 0.11 at 1 month. In Group
190
A, the IOL position was 0.36 ± 0.05 at 1 week and 0.35 ± 0.05 at 1 month. In Group B,
191
the IOL position was 0.31 ± 0.11 at 1 week and 0.32 ± 0.11 at 1 month. In Group C, the
192
IOL position was 0.22 ± 0.16 at 1 week and 0.25 ± 0.15 at 1 month. The IOL position
193
moved significantly forward in Group C, compared with those in other two groups
194
(P<0.001 at 1 week, P<0.001 at 1 month). The degree of IOL tilt was significantly larger
195
in Group C than those in the other two groups, but only at 1 week (P=0.004) (Table 3).
196
There was no significant difference of IOL decentration in three groups (P=0.08) (Table
197
3).
198
The relationship between IOL status and postoperative refractive error
199
The forward movement of the IOL position was significantly correlated with greater
200
ME at 1 month (R=0.53, P<.0001).
201
Relationship among ACW and postoperative values
13
202
Preoperative ACW was not significantly correlated with postoperative AQD (P=0.12).
203
There was no significant relationship between preoperative ACW and ME at 1 month
204
(P=0.32).
205
206
Discussion
207
In this study, we compared the refractive outcomes and SS-ASOCT parameters in three
208
groups, i.e. the “cataract surgery group (Group A)”, “vitrectomy without gas tamponade
209
group (Group B)”, and “vitrectomy with gas tamponade group (Group C)”. The reason
210
for these classifications was to evaluate the influence of gas tamponade and vitrectomy
211
on the lens position and refractive outcomes.
212
The difference between predicted and achieved refraction was not
213
significantly different at 1 week and at 1 month postoperatively in both the “cataract
214
surgery” group and “vitrectomy without gas tamponade” group. Danjo et al. reported
215
that the reason of the myopic shift after vitrectomy was associated with the replacement
216
of vitreous with aqueous humor with a lower refractive index and the change in the
217
AQD.14 However, in this study, the position of IOL was not significantly different at 1
14
218
month postoperatively between the “cataract surgery” and “vitrectomy without gas
219
tamponade” groups, indicating that simple vitrectomy does not have a significant
220
influence on postoperative refractive errors and position of the IOL.
221
A greater myopic shift was observed postoperatively in the “vitrectomy with
222
gas tamponade” group compared with that in the other two groups, as reported
223
previously.15 In the multivariate regression analysis, the presence of gas tamponade was
224
the only factor significantly associated with myopic shift at 1 month. Myopic shift after
225
vitrectomy with gas tamponade has been reported to be associated with forward
226
movement of the IOL caused by buoyancy and surface tension of the gas. In this study,
227
the postoperative AQD at 1 month was significantly shallower in the “vitrectomy with
228
gas tamponade” group, compared with that in the other two groups. In addition, the
229
postoperative AQD was shallower at 1 week than at 1month postoperatively in the
230
“vitrectomy with gas tamponade” group. This is because the buoyancy and surface
231
tension of the gas pushed the IOL after the vitrectomy with gas tamponade procedure,
232
even if the patients maintained a strict prone position. This resulted in the position of
233
the IOL being fixed in a forward position in the “vitrectomy with gas tamponade” group,
15
234
even after the gas disappeared after 1 month postoperatively. It was notable that the
235
forward IOL position significantly correlated with the myopic shift postoperatively in
236
the current study. In contrast to the forward movement of the IOL, the tilt of the IOL
237
became similar to the tilt after cataract surgery at 1 month, although the tilt was
238
significantly greater at 1 week in eyes that underwent vitrectomy with gas tamponade.
239
In summary, the current study confirmed that the gas pushes the IOL forward
240
for at least 1 week after vitrectomy, resulting in tilt and forward movement of the IOL
241
and a shallow AQD. As the gas spontaneously decreases over time, the pushing power
242
of the gas weakens, resulting in backward movement of the IOL, a deeper AQD, and
243
normalization of the IOL tilt. However, the IOL does not return to the same position as
244
in eyes following cataract surgery and vitrectomy without gas tamponade. Consequently,
245
the postoperative AQD was shallower compared to that in cases after cataract surgery,16
246
and the IOL was fixed in a forward position even after gas resolution, leading to the
247
postoperative myopic shift.
248
This study has several limitations, including its retrospective design, a relatively
249
small sample size, and a short study period. Minor differences in the extent of vitreous
16
250
base shaving in each patients may have potentially influenced the zonular laxity
251
affecting the position of the IOL. Therefore, further studies with a larger number of
252
patients are necessary to validate the current results and to improve understanding of
253
IOL position and refractive outcomes in cataract surgery and vitrectomy with gas
254
tamponade. Nevertheless, the current study reveals that forward movement of the IOL
255
correlated with the myopic shift in eyes that underwent vitrectomy with gas tamponade
256
based on SS-ASOCT measurements. Our findings are valuable for improving our
257
understanding of the IOL position after surgery and to help prevent refractive error in
258
eyes treated with phacovitrectomy.
17
259
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Segment Optical Coherence Tomography Study. Sci Rep. 2018;8:10230.
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13. Hoffer KJ, Aramberri J, Haigis W, et al. Protocols for studies of intraocular lens formula accuracy. Am J Ophthalmol. 2015;160:1086-7.
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14. Danjo Y, Mitsuda H, Maeno T. Cataract surgery for avitreous eyes-postoperative refractive prediction error. Folia Ophthalmol Jpn. 1993;44:1243–1247.
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15. Patel D, Rahman R, Kumarasamy M. Accuracy of intraocular lens power estimation
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in eyes having phacovitrectomy for macular holes. J Cataract Refract Surg.
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Figure legend
323 324
Figure 1. Parameters of swept-source anterior segment optical coherence tomography
325
after cataract surgery and phacovitrectomy. (A) Aqueous depth (AQD) and relative IOL
326
position 1 month after cataract surgery (Group A). AQD is 4.25 ± 0.35 mm. Position of
327
the IOL (0.36) was calculated assuming that the original lens thickness was 1. (B) AQD
328
and IOL position 1 month after phacovitrectomy without gas tamponade (Group B).
329
AQD is 4.30 ± 0.26 mm. Position of the IOL was 0.32. (C) AQD and IOL position 1
330
week after phacovitrectomy with gas tamponade (Group C). AQD is 3.95 ± 0.33 mm.
331
Position of the IOL was 0.22. (D) AQD and IOL position 1 month after
332
phacovitrectomy with gas tamponade (Group C). AQD is 4.09 ± 0.21 mm. Position of
333
the IOL was 0.25.
334 335 336
20
Table 1. Patient characteristics Overall
Group A
Group B
Group C
P value
20/20 22/22 34/34 No. of eyes/No. of patients 76/76 0.001 68.6±11.2 64.8±8.1 69.6±9.5 73.8±7.5 Age (yrs) (mean ± SD) 9 (41) 0.3 20 (59) 12 (60) Gender, no. of women (%) 41 (54) 0.9 10 (45) 40 (53) 17 (50) 11 (55) Eye, no. of right eyes (%) 0.53±0.56 0.03 0.53±0.75 Preoperative BCVA, LogMAR (mean ± SD) 0.38±0.55 0.21±0.32 24.16±1.38 24.13±1.37 0.9 24.12±1.4 Axial length (mm) 24.13±1.36 0.1 2.55±0.45 2.80±0.52 2.92±0.70 2.73±0.57 Aqueous depth (AQD) (mm) (mean ± SD) 0.4 11.57±0.42 11.67±0.41 11.74±0.35 11.69±0.48 Anterior chamber width (ACW) (mm) (mean ± SD) 541.73±32.10 0.76 Central corneal thickness (CCT) (mm) (mean ± SD) 541.70±26.20 539.62±24.53 545.25±22.50 4.71±0.40 4.54±0.52 4.34±0.54 0.03 Lens Thickness (mm) (mean ± SD) 4.56±0.49 BCVA; best-corrected visual acuity, logMAR; logarithm of the minimum angle of resolution, SD; standard deviation. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Table 2. Refractive outcomes Overall
Group A
Group B
Group C
P value
MedAE at 1 week 0.36 0.32 0.27 0.38 ME at 1 week (mean ± SD) -0.30 ± 0.87 0.05 ± 0.87 -0.26 ± 0.93 -0.73 ± 0.65 <.001 MedAE at 1 month 0.34 0.31 0.20 0.47 ME at 1 month (mean ± SD) -0.22 ± 0.62 0.08 ± 0.39 -0.07 ± 0.45 -0.82 ± 0.64D <.001 ME; mean refractive prediction error. MedAE; median absolute error. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Table 3. Postoperative parameters of swept-source anterior segment optical coherence tomography Overall
Group A
Group B
Group C
P value
1 week postoperatively Aqueous depth (AQD) (mm) (mean ± SD) 4.17±0.35 4.28±0.32 4.23±0.3 3.95±0.33 <.001 Changes in AQD (mm) (mean ± SD) 1.44±0.56 1.73±0.33 1.43±0.51 1.03±0.62 <.001 IOL position (mm) (mean ± SD) 0.31±0.12 0.36±0.05 0.31±0.11 0.22±0.16 <.001 IOL tilt (mm) (mean ± SD) 4.79±2.29 3.89±2.06 5.12±1.86 5.86±2.50 0.004 IOL decentration (mm) (mean ± SD) 0.35±0.28 0.33±0.26 0.44±0.38 0.29±0.19 0.5 1 month postoperatively Aqueous depth (AQD) (mm) (mean ± SD) 4.21±0.3 4.25±0.35 4.30±0.26 4.09±0.21 0.02 Changes in AQD (mm) (mean ± SD) 1.48±0.51 1.70±0.31 1.50±0.50 1.17±0.62 <.001 IOL position (mm) (mean ± SD) 0.32±0.11 0.36±0.05 0.32±0.11 0.25±0.15 <.001 IOL tilt (mm) (mean ± SD) 5.02±1.94 4.99±1.97 5.15±2.09 4.97±1.83 0.9 IOL decentration (mm) (mean ± SD) 0.38±0.31 0.31±0.25 0.39±0.29 0.48±0.39 0.08 IOL; intraocular lens, SD; standard deviation. Group A; Cataract surgery group. Group B; Phacovitrectomy without gas group. Group C; Phacovitrectomy with gas group.
Highlights Swept-source anterior segment optical coherence tomography analysis identified that the forward movement of the intraocular lens position significantly correlated with a greater refractive error after phacovitrectomy with gas tamponade.