Stabilization of refractive error and associated factors following small incision phacoemulsification cataract surgery
Tóm tắt
Accumulating evidence suggests that refractive stabilization occurs rapidly following small incision cataract surgery. Nonetheless, many guidelines still suggest waiting four to 6 weeks before prescribing corrective lenses. This study was undertaken to supplement the existing literature regarding refractive stabilization, and evaluate multiple contributing factors that could dissuade clinicians from confidently correcting refractive error in the early post-operative course following routine cataract surgeries.
Adult patients undergoing phacoemulsification cataract surgery with uncomplicated surgeries and post-surgical courses at the Calgary Ophthalmology Centre (Calgary, Alberta, Canada) were included in this prospective observational case series. Exclusion criteria included known corneal dystrophies, infectious keratitis, complicated surgery or toric/multifocal IOLs. Data was collected at weekly intervals for a total of 6 weeks. Collected data included autorefraction, visual acuity, corneal pachymetry, and effective lens position.
One hundred six eyes of 104 patients were included in this study. Post-operative sphere, cylinder and spherical equivalent were not significantly different at any post-operative week compared with week six, and 80–86% of patients were within 0.5D of last follow-up spherical equivalent at any week. The secondary outcomes of central corneal thickness, effective lens position and visual acuity did, however, exhibit significant differences between early post-operative weeks and last follow-up values.
These data suggest that refractive error can be effectively measured and corrected as early as one-week post-operatively in the majority of patients, though other measures of post-operative stability including central corneal thickness, effective lens position and visual acuity can require up to 4 weeks to stabilize. Thus a conservative and pragmatic approach may be to wait until 4 weeks post-operatively prior to obtaining refractive correction following uncomplicated phacoemulsification cataract surgery.
Từ khóa
Tài liệu tham khảo
Brown MC, Schallhorn S. Redefining refractive stability: an analysis of over 250,000 patients. Invest Ophthalmol Vis Sci. 2011;52:5899.
Preoperative assessment and biometry. In: Cataracts in adults: management. London: National Institute for Health and Care Excellence (UK); 2017 Oct. (NICE Guideline, No. 77.) 7, National Institute for Health and Care Excellence, 2017.
See CW, Iftikhar M, Woreta FA. Preoperative evaluation for cataract surgery. Curr Opin Ophthalmol. 2019;30:3–8.
Astbury N, Nyamai LA. Detecting and managing complications in cataract patients. Community Eye Health. 2016;29:27–9.
Baranyovits PR. Stabilisation of refraction following cataract surgery. Br J Ophthalmol. 1988;72:815–9.
Oshika T, Tsuboi S. Astigmatic and refractive stabilization after cataract surgery. Ophthalmic Surg. 1995;26:309–15.
Charlesworth E, Alderson AJ, de Juan V, Elliott DB. When is refraction stable following routine cataract surgery? A systematic review and meta-analysis. Ophthalmic Physiol Opt. 2020;40:531–9.
McNamara P, Hutchinson I, Thornell E, Batterham M, Iloski V, Agarwal S. Refractive stability following uncomplicated cataract surgery. Clin Exp Optom. 2019;102:154–9.
Caglar C, Batur M, Eser E, Demir H, Yasar T. The stabilization time of ocular measurements after cataract surgery. Semin Ophthalmol. 2017;32:412–7.
de Juan V, Herreras JM, Perez I, Morejon A, Rio-Cristobal A, Martin R, et al. Refractive stabilization and corneal swelling after cataract surgery. Optom Vis Sci. 2013;90:31–6.
Mojon-Azzi SM, Sousa-Poza A, Mojon DS. Impact of low vision on well-being in 10 European countries. Ophthalmologica. 2008;222:205–12.
Jivrajka RV, Shammas MC, Shammas HJ. Improving the second-eye refractive error in patients undergoing bilateral sequential cataract surgery. Ophthalmology. 2012;119:1097–101.
Tiew S, Lim C, Sivagnanasithiyar T. Using an excel spreadsheet to convert Snellen visual acuity to LogMAR visual acuity. Eye. 2020.
Fallah Tafti MR, Abdollah Beiki H, Mohammadi SF, Latifi G, Ashrafi E, Fallah TZ. Anterior chamber depth change following cataract surgery in Pseudoexfoliation syndrome; a preliminary study. J Ophthalmic Vis Res. 2017;12:165–9.
Ostri C, Holfort SK, Fich MS, Riise P. Automated refraction is stable 1 week after uncomplicated cataract surgery. Acta Ophthalmol. 2018;96:149–53.
Lake D, Fong K, Wilson R. Early refractive stabilization after temporal phacoemulsification: what is the optimum time for spectacle prescription? J Cataract Refract Surg. 2005;31:1845.
Elliott M, Simpson T, Richter D, Fonn D. Repeatability and accuracy of automated refraction: a comparison of the Nikon NRK-8000, the Nidek AR-1000, and subjective refraction. Optom Vis Sci. 1997;74:434–8.
Bullimore MA, Fusaro RE, Adams CW. The repeatability of automated and clinician refraction. Optom Vis Sci. 1998;75:617–22.
Kongsap P. Central corneal thickness changes following manual small incision cataract surgery versus phacoemulsification for white cataract. Rom J Ophthalmol. 2019;63:61–7.
Jeancolas AL, Lhuillier L, Renaudin L, Boiche M, Ghetemme C, Goetz C, et al. Central corneal thickness assessment after phacoemulsification: subluxation versus divide-and-conquer. J Fr Ophtalmol. 2017;40:744–50.
Engren AL, Behndig A. Anterior chamber depth, intraocular lens position, and refractive outcomes after cataract surgery. J Cataract Refract Surg. 2013;39:572–7.
Ning X, Yang Y, Yan H, Zhang J. Anterior chamber depth - a predictor of refractive outcomes after age-related cataract surgery. BMC Ophthalmol. 2019;19:134.
Klijn S, Sicam VA, Reus NJ. Long-term changes in intraocular lens position and corneal curvature after cataract surgery and their effect on refraction. J Cataract Refract Surg. 2016;42:35–43.
Koeppl C, Findl O, Kriechbaum K, Buehl W, Wirtitsch M, Menapace R, et al. Postoperative change in effective lens position of a 3-piece acrylic intraocular lens. J Cataract Refract Surg. 2003;29:1974–9.
Li S, Li X, He S, Zheng Q, Chen X, Wu X, et al. Early postoperative rotational stability and its related factors of a single-piece acrylic toric intraocular lens. Eye. 2020;34:474–9.
Meduri A, Urso M, Signorino GA, Rechichi M, Mazzotta C, Kaufman S. Cataract surgery on post radial keratotomy patients. Int J Ophthalmol. 2017;10:1168–70.