Refractive result after clear lens extraction in posterior microphthalmos with high hyperopia.

Area of Science:

• Ophthalmology
• Refractive Surgery
• Biomedical Engineering

Background:

• A young adult presented with severe hyperopia (+13.00 sphere) and reduced visual acuity (20/60), necessitating refractive surgery evaluation.
• Ocular examination revealed posterior microphthalmos with associated retinal folds, complicating standard intraocular lens (IOL) power calculations.

Purpose of the Study:

• To assess the accuracy of various intraocular lens (IOL) power calculation formulas in a case of posterior microphthalmos with extreme hyperopia.
• To determine the most suitable formula for optimizing refractive outcomes after clear lens extraction in this unique patient profile.

Main Methods:

• Preoperative assessment included best corrected visual acuity and manifest refraction.
• Posterior segment examination identified pseudopapilloedema, papillomacular retinal fold, and chorioretinal fold.
• Multiple IOL power calculation formulas were applied, followed by bilateral clear lens extraction.

Main Results:

• Post-surgery, residual spherical equivalents were +4.50 OD and +3.375 OS.
• No existing IOL formula accurately predicted the required power for this extreme hyperopia and posterior microphthalmos.
• The Hoffer Q formula demonstrated the minimal refractive error among the tested formulas.

Conclusions:

• Accurate IOL power calculation remains challenging in eyes with posterior microphthalmos and extreme hyperopia.
• The Hoffer Q formula may offer the least refractive error in such complex cases, guiding surgical planning.
• Further research into specialized IOL calculation methods for microphthalmic eyes is warranted.