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Longitudinal Biometric Changes and Intraocular Lens Calculation Formula Accuracy in Delayed Cataract Surgery Cases.

Shohei Nishida¹, Akira Hirata², Yasuya Inomata¹

¹Department of Ophthalmology, Inomata Eye Clinic, Kumamoto City, Kumamoto, Japan.

Clinical Ophthalmology (Auckland, N.Z.)

|March 20, 2026

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For delayed cataract surgery, refractive error predictions vary between initial and remeasured ocular parameters. Specific intraocular lens (IOL) calculation formulas like Haigis and EVO showed significant myopic shifts, impacting IOL power selection.

Area of Science:

Ophthalmology
Refractive Surgery
Biomedical Engineering

Background:

Delayed cataract surgery, defined as postponement exceeding three months, presents unique challenges for accurate intraocular lens (IOL) power calculation.
Changes in ocular parameters over time can affect the predictability of postoperative refractive error (PE).

Purpose of the Study:

To compare postoperative refractive error (PE) calculated using various intraocular lens (IOL) calculation formulas based on initial versus remeasured ocular parameters in eyes undergoing delayed cataract surgery.
To assess the impact of changes in axial length, keratometric power, anterior chamber depth (ACD), and lens thickness (LT) on IOL power calculations.

Main Methods:

A cohort of 57 eyes undergoing delayed cataract surgery (average delay of 14 months) was analyzed.

Keywords:

lens thickness ocular parameters phacoemulsification postoperative refractive error

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Initial and remeasured ocular parameters (axial length, keratometric power, ACD, LT) were obtained.

Postoperative refractive errors were calculated using Sanders-Retzlaff-Kraff/Theoretical (SRK/T), Haigis, Barrett Universal II (BU II), Kane, and Emmetropia Verifying Optical (EVO) formulas, comparing results from initial and remeasured data.

Main Results:

Significant changes in ocular parameters were observed: ACD deepened and LT thinned between initial and remeasured assessments.
The Haigis and EVO formulas demonstrated a significant myopic shift in mean PE when using remeasured data compared to initial data.
No significant differences in mean absolute error or median absolute error were found among the formulas, but LT emerged as a significant factor for the Haigis formula in regression analysis.

Conclusions:

The choice of intraocular lens (IOL) calculation formula is critical for optimizing refractive outcomes in delayed cataract surgery.
Formula-specific characteristics and potential changes in ocular parameters over time, particularly lens thickness, should be considered when selecting IOL power.