Audit of Biometric Accuracy and Postoperative Refractive Outcomes Following Cataract Surgery.
Clinical Audit
DOI:
https://doi.org/10.69837/pjammr.v4i1.114Keywords:
Cataract surgery; Optical biometry; Intraocular lens power calculation; Refractive outcomes; Clinical audit; PhacoemulsificationAbstract
Objective: The purpose of this study was to assess the level of accuracy of the biometric parameters obtained preoperatively to predict the postoperative refractive outcomes after uncomplicated cataract surgery and to determine the factors that correlate with the refractive prediction error.
Methodology: A retrospective observational clinical audit was conducted in the Department of Ophthalmology, MMC/Bacha Khan Medical College, Mardan, Pakistan, from 15 January to 15 June 2025. A consecutive non-probability sampling technique was used to recruit eligible patients. Patients with prior eye surgery, corneal disease, traumatic cataract, or intraoperative complications were excluded. Optical biometry, including axial length, keratometry, anterior chamber depth (ACD), and predicted refraction (PR), was performed. All patients were evaluated six weeks after surgery for manifest refraction. The mean absolute prediction error (MAE) was the primary outcome measure.
Results: Among the 100 patients, 58% were males and 42% females, with a mean age of 65.4 ± 8.7 years. Mean axial length was 23.52 ± 1.08 mm, keratometry 43.78 ± 1.64 D, and IOL power 21.43 ± 2.86 D. The postoperative spherical equivalent was −0.18 ± 0.42 D, with an MAE of 0.39 ± 0.27 D. Overall, 84% of eyes achieved refraction within ±0.50 D and 95% within ±1.00 D of the intended target. Best-corrected visual acuity of 6/9 or better was achieved in 92% of patients. Eyes with normal axial length demonstrated significantly lower prediction errors than those with short or long axial lengths (0.34 ± 0.21 D vs. 0.56 ± 0.33 D; p=0.003), while gender showed no significant association with refractive accuracy (p=0.481).
Conclusion: Modern optical biometry demonstrated excellent refractive predictability following uncomplicated cataract surgery. Eyes with abnormal axial lengths exhibited significantly higher prediction errors, underscoring the importance of optimized biometric assessment for improving postoperative refractive outcomes
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