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The Barrett Universal II formula showed the best refractive prediction accuracy for long axial length eyes after flanged intrascleral intraocular lens (IOL) fixation. Other formulas like Holladay 1 had systematic errors despite appearing accurate in long eyes.

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Area of Science:

  • Ophthalmology
  • Refractive Surgery
  • Biomedical Engineering

Background:

  • Accurate intraocular lens (IOL) power calculation is crucial for successful refractive outcomes after cataract surgery.
  • Long axial length (AL) eyes present unique challenges for IOL power calculation formulas.
  • Flanged intrascleral IOL fixation (SF-IOL) is a technique used for IOL implantation, particularly in complex cases.

Purpose of the Study:

  • To evaluate and compare the refractive prediction accuracy of standard IOL power calculation formulas in eyes with long AL undergoing SF-IOL.
  • To identify the most reliable formula for optimizing refractive outcomes in this specific patient cohort.

Main Methods:

  • Retrospective observational cohort study including eyes that underwent SF-IOL.
  • Eyes were categorized into normal AL (<26.0 mm) and long AL (≥26.0 mm) groups.
  • The refractive prediction error (PE) and accuracy of four formulas (Barrett Universal II, Hoffer Q, Holladay 1, SRK/T) were assessed using root mean square absolute error (RMSAE) and Formula Performance Index (FPI).

Main Results:

  • Fifty-three eyes were analyzed, with 18 classified as long AL (mean AL 27.1±1.0 mm).
  • The Barrett Universal II formula demonstrated the lowest RMSAE and highest FPI across all eyes, indicating superior overall predictive accuracy.
  • While Holladay 1 showed a PE closer to zero in the long AL group, its performance was characterized by a steep AL-PE regression slope and a low FPI, suggesting systematic bias rather than true accuracy.

Conclusions:

  • The Barrett Universal II formula is the most accurate for predicting refractive outcomes in long AL eyes after SF-IOL implantation.
  • Formulas like Holladay 1 may appear accurate due to systematic offset in long AL eyes, but their overall performance and reliability are lower.
  • These findings emphasize the importance of selecting appropriate IOL calculation formulas based on AL for optimizing surgical results.