Purpose: To assess the axial length (AL) measurement failure rate using partial-coherence interferometry (PCI) and swept-source optical coherence tomography (SS-OCT) in dense cataracts. As a secondary outcome, the SS-OCT biometry was compared to immersion ultrasound. Methods: This is a prospective cross-sectional and comparative study. Seventy eyes from 70 patients with dense cataracts were enrolled in this study. Dense cataract was defined according to the Lens Opacities Classification System III (LOCS III) scores equal to or more than NO4, NC4, C4, and P3. The failure rate of AL measurement was evaluated using PCI and SS-OCT. Anterior chamber depth (ACD), lens thickness (LT), and AL measurements obtained by SS-OCT were compared with IUS. Results: AL measurement failure rate with PCI was 68.57% and 21.43% with SS-OCT ( P = 0.007). AL measurement was achieved in 69.23% of NO4, 66.6% of P3, and 15.3% of mixed cataracts using PCI, while SS-OCT was achieved in 100% of NO4, NO5, P3, and P5 and 76.9% of mixed cataracts. Cortical cataracts alone did not influence AL measurement. Biometric data of ACD, LT, and AL were statistically different comparing US and SS-OCT with a good correlation of AL. Conclusion: SS-OCT significantly improves the rate of successful AL measurements when compared to PCI in dense cataracts. The LOCS III clinical cut-off for the use of SS-OCT ocular biometry may well be up to P4 and NO5.

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