Theoretical evaluation of the cataract extraction-refraction-implantation techniques for intraocular lens power calculation

PURPOSE: To evaluate theoretically three previously published formulae that use intra-operative aphakic refractive error to calculate intraocular lens (IOL) power, not necessitating pre-operative biometry. The formulae are as follows: IOL power (D) = Aphakic refraction x 2.01 [Ianchulev et al., J. Cataract Refract. Surg.31 (2005) 1530]; IOL power (D) = Aphakic refraction x 1.75 [Mackool et al., J. Cataract Refract. Surg.32 (2006) 435]; IOL power (D) = 0.07x(2) + 1.27x + 1.22, where x = aphakic refraction [Leccisotti, Graefes Arch. Clin. Exp. Ophthalmol.246 (2008) 729]. METHODS: Gaussian first order calculations were used to determine the relationship between intra-operative aphakic refractive error and the IOL power required for emmetropia in a series of schematic eyes incorporating varying corneal powers, pre-operative crystalline lens powers, axial lengths and post-operative IOL positions. The three previously published formulae, based on empirical data, were then compared in terms of IOL power errors that arose in the same schematic eye variants. RESULTS: An inverse relationship exists between theoretical ratio and axial length. Corneal power and initial lens power have little effect on calculated ratios, whilst final IOL position has a significant impact. None of the three empirically derived formulae are universally accurate but each is able to predict IOL power precisely in certain theoretical scenarios. The formulae derived by Ianchulev et al. and Leccisotti are most accurate for posterior IOL positions, whereas the Mackool et al. formula is most reliable when the IOL is located more anteriorly. CONCLUSION: Final IOL position was found to be the chief determinant of IOL power errors. Although the A-constants of IOLs are known and may be accurate, a variety of factors can still influence the final IOL position and lead to undesirable refractive errors. Optimum results using these novel formulae would be achieved in myopic eyes.