Development and Evaluation of the Prognostic Nomogram to Predict Refractive Error in Patients With Primary Angle-Closure Glaucoma Who Underwent Cataract Surgery Combined With Goniosynechialysis

Abstract

Objective: To evaluate the accuracy of different intraocular lens (IOL) power calculation formulas and develop prognostic nomograms to predict the risk of postoperative refractive error in primary angle-closure glaucoma (PACG) patients.Methods: A total of 111 eyes with PACG underwent goniosynechialysis combined with phacoemulsification and IOL implantation were included. SRK/T, Barrett II, Hoffer Q, and Kane formulas were used to predict postoperative refraction. Prediction error (PE) and absolute predictive error (APE) produced by the four formulas were calculated and compared. An APE >0.50 D was defined as the event. Binary logistic regression analysis and prognostic nomogram models were conducted to investigate reliable predictors associated with postoperative refraction.Results: The Kane (−0.06 D) and Barrett II (−0.07 D) formulas had mean prediction error close to zero (p = 0.44, p = 0.41, respectively). The Hoffer Q and SRK/T produced significantly myopic outcomes (p = 0.003, p = 0.013, respectively). The percentage of eyes within ± 0.5 D was 49.5% (55/111), 44.1% (49/111), 43.2% (48/111), and 49.5% (54/111), for the Kane, Barrett II, Hoffer Q, and SRK/T formula, respectively. Nomogram showed that AL had the greatest impact on the refractive outcomes, indicating a shorter preoperative AL is associated with a greater probability of refractive error event. The area under the receiver operator curve (AUC) of the nomogram for the Kane, Barrett II, Hoffer Q, and SRK/T was 0.690, 0.701, 0.708, and 0.676, respectively.Conclusions: The Kane and Barrett II formulas were comparable, and they outperformed Hoffer Q and SRK/T in the total eyes with PACG receiving cataract surgery combined with goniosynechialysis. The developed nomogram models can effectively predict the occurrence of postoperative refractive error events.

Anterior Segment Changes and Refractive Outcomes after Cataract Surgery Combined with Gonioscopy-Assisted Transluminal Trabeculotomy in Open-Angle Glaucoma

“…The Kane (-0.06 D) and Barrett II (-0.07 D) formulas had a mean PE close to zero, while the Hoffer Q (-0.26 D) and SRK/T (-0.21 D) produced significantly myopic outcomes. 28 Although SRK/T showed significantly more myopic outcomes among the four formulas in our study, the mean PE (-0.08 D) was closer to zero than in the study by Li et al 28 This difference may be due to the inclusion of eyes with PACG in the previous study.…”

“…A few studies have evaluated refractive results with different IOL formulas in combined cataract and glaucoma surgery. 26 , 27 , 28 Iijima et al 26 compared the accuracy of IOL power calculation using the SRK/T and Barrett-Universal II formulas in 56 eyes after combined trabeculectomy and cataract extraction and found that the Barrett provided a smaller absolute error. Marta et al 27 analyzed refractive errors in the Haigis, SRK/T, Holladay 1, Hoffer Q, Barrett-Universal II, Hill-RBF, and Kane formulas in combined cataract surgery and Ahmed glaucoma valve implantation.…”

“…They reported that in the eyes with anterior chamber implant, the formula with the best PE was Barrett II. Li et al 28 evaluated the accuracy of SRK/T, Hoffer Q, Barrett II and Kane formulas in 111 eyes with primary angle-closure glaucoma (PACG) that underwent goniosynechialysis with phacoemulsification. The Kane (-0.06 D) and Barrett II (-0.07 D) formulas had a mean PE close to zero, while the Hoffer Q (-0.26 D) and SRK/T (-0.21 D) produced significantly myopic outcomes.…”

A systemic review and network meta-analysis of accuracy of intraocular lens power calculation formulas in primary angle-closure conditions

“…Consequently, discrepancies are unsurprising in IOL prediction in eyes with PACD. Additionally, currently available studies conducted among PACD eyes showed divergent accuracies of different formulas [7,9,21,[24][25][26]. All these facts stress the importance of our study.…”

“…severe pterygium, severe corneal or vitreous opacity, macular degeneration, and retinal detachment, etc. [21]); 3) preoperative ocular biometric measurements performed with instruments other than IOLMaster; 4) studies that did not provide targeted outcome data or that were computationally unavailable.…”