IOL Calculation Quandaries 1 Case #1 2 • PPLOV OU 10/2012: • OD -6.50 +1.00 x 170 20/30 (BAT 20/70) • OS -13.75 +0.50 x 170 20/40 (BAT 20/80) • Milky NSC OS > OD (“Myopic cataracts”) • 59-y/o ♂ w/ h/o: • RD OS s/p SB • Zoster keratitis/ trabeculitis s/p tube shunt OD IOL Calcs - Lenstar • Axial length: • OD 27.32 mm • OS 29.57 mm • Auto-keratometry: • OD 42.29/43.00 @ 159 • Avg 42.64 • OS 42.46/42.77 @ 139 • Avg 42.61 • IOL = SN60WF: • OD 11.0D → SE -0.43D • OS 5.0D → SE -0.41D 3 } Δ 2.25 IOL Calcs - IOLMaster • Axial length: • OD 27.25 mm • OS 29.50 mm • Auto-keratometry: • OD 42.29/43.21 @ 150 • Avg 42.75 • OS 42.67/42.83 @ 173 • Avg 42.75 • IOL = SN60WF: • OD 11.0D → SE -0.47D • OS 5.0D → SE -0.45D 4 Are we good? } Δ 2.25 Long Eyes • Standard calcs result in hyperopic errors • Adjusted axial length: • Holladay 1 formula • New axial lengths: • OD 26.85 mm (from 27.25 mm) • OS 28.72 mm (from 29.5 mm) • IOL = SN60WF: • OD 12.0D → SE -0.34D • OS 6.5D → SE -0.17D 5 ALADJ = (0.8289 * ALIOLM) + 4.2663 Post-Op UCVA 20/20 OU *Wang L, et al. J Cataract Refract Surg 2011; 37(11):2018-2027 Case #2 6 • PPLOV & Monocular Diplopia OU 11/2012: • OD +1.25 +1.00 x 025 20/40- (BAT 20/70) • OS +1.00 +0.25 x 010 20/50 (BAT 20/80) • Nuclear & cortical cataracts OU • 68-y/o ♂ w/ Fuch’s s/p DSAEK OU: • OS 2005, OD 2006 • Post-Op BCVA 20/20 OU