Refractive surprise after cataract surgery secondary to smeared optics of swept-source optical coherence tomography biom
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CASE REPORT
Open Access
Refractive surprise after cataract surgery secondary to smeared optics of sweptsource optical coherence tomography biometer: a case report Francis Carr*
and Vinod Gangwani
Abstract Background: Inaccurate biometry can lead to the wrong intraocular lens implantation and result in refractive surprise following cataract surgery. It is important to be sceptical of biometry results that do not match the refractive or clinical picture and ask for it to be repeated. Case presentation: We present a unique cause of refractive surprise in a patient undergoing cataract surgery. Preoperative refraction demonstrated hypermetropia, yet swept-source optical coherence tomography (SS-OCT) biometry repeatedly calculated the axial length as > 35.00 mm in both eyes. The patient underwent phacoemulsification and intraocular lens insertion using the provided biometry calculations, however postoperatively the patient had a + 14.00 dioptre refractive surprise. Analysis of biometry performed on the same day identified other patients with exaggerated axial lengths, supporting the theory that the biometer’s smeared optical surface was responsible. Following servicing of the machine, repeat biometry of the patient calculated the axial length consistent with a hypermetrope (21.67 mm) and the intraocular lens exchange was successful in correcting the refractive error. Conclusions: Ensure the optical surfaces of the biometer are cleaned regularly, and consider repeating biometry on separate days if repeat biometry still is not in keeping with the refractive or clinical picture. Additionally, re-confirm the axial length with another modality. Keywords: Biometer error, Biometry, Swept-source optical coherence tomography, Refractive surprise, Cataract surgery, Case report
Background Cataract surgery with intraocular lens implantation most often attempts to achieve a refractive result close to emmetropia and reduce spectacle dependence. To obtain this, an accurate intraocular lens calculation is compulsory and axial length measurement is perhaps the most influential parameter in this calculation [1]. Axial length * Correspondence: [email protected] Department of Ophthalmology, Ashford and St Peter’s Hospitals, Surrey KT16 0PZ, UK
is commonly measured using partial coherence interferometry and recently with SS-OCT, as it offers advantages over ultrasound biometry, such as greater precision, unaffected by velocity estimates and measuring along the visual axis [2–4]. Despite the evolving technologies, formulae and protocols, the intended post-operative refractive target is not always achieved [5]. This is termed a ‘refractive surprise’ and is a source of patient disappointment due to unmet expectations [6–8]. We report a case of wrong
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the
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