OPTIMISING

IOL POWER CALCULATION IN EYES

WITH
POSTERIOR SEGMENT DISEASES
AND
FOLLOWING POSTERIOR SEGMENT SURGERY

Dr Meena Chakrabarti MS

Dr Arup Chakrabarti MS

Chakrabarti eye care centre, Trivandrum

Email:- drmeenachakrabarti@gmail.com
Introduction
With the advent of a better understanding of the underlying pathophysiology of retinal
disease, availability of better instrumentation,and refinement of available technologies and
techniques, the visual outcome following surgical management of patients with vitreoretinal
pathologies have improved by leaps and bounds. The indications for vitreoretinal surgeries
have expanded tremendously resulting in more number or patients requiring cataract surgery
either in combination with the vitreoretinal procedure or later on as a second stage
procedure. Coupled with these developments is the welcome trend of novice surgeons
choosing to specialise in vitreoretinal surgery, resulting in an exponential increase in the
number of vitreoretinal procedures performed yearly

One of the most common complications of vitrectomy is the earlier onset and more rapid
progression of lenticular opacity especially nuclear sclerotic cataract and posterior subcapsular
opacification.Studies have suggested that lighttoxicity, oxidation of lens proteins, use of
intraocular gas or silicone oil, length of surgery,mechanical trauma, and increased
postoperative oxygen tension within the eye may becausative factors of cataract following
PPV.Postvitrectomy cataract such asnuclear sclerotic cataract is clinically challenging due to
the lack of vitreous support inthe posterior segment and the relatively harder nucleus than in
age-related cataract,which increase the risk of surgical complications. With appropriate
surgical techniques, cataract surgery in vitrectomised eyes can be safe & effective with
refractive outcomes similar to non vitrectomised eyes although the underlying retinal
pathology may limit the functional outcome and increase the risks for intraoperative and
postoperative complications. Presence of dense nuclear sclerosis, hard cataract, pre existing
zonular dialysis or posterior capsular rent as well as higher incidence of postoperative cystoid
macular edema, earlier onset of posterior capsular opacification and capsular bag contracture
can complicate the intra and postoperative course. Another major challenge is obtaining an
accurate biometry and axial length measurement as well as precise calculation of IOL power in
these eyes.

This review will deal with all factors which should be considered to facilitate a precise
estimation of IOL power for achieving the desired refraction after cataract surgery.

IOL consideration in eyes with posterior segment pathology or following posterior segment
surgeries in associated with

1. Challenges for Axial Length determination

2. Inaccuracies regarding choice of an appropriate IOL power

Challenges involved in Axial length measurement
Errors in axial length measurement contribute maximally to wrong IOL power estimation
in eyes with post vitrectomy cataracts. Olsen et al and Mc Ewan et al have conclusively
reported that more than 54% of error are attributable to inaccurate axial length
measurement.

Error in Axial length measurement can arise due to

1. Over estimation of axial length in silicone oil filled eyes.

2. Underestimation of axial length in eyes with macular edema, when ultrasound biometry is
used.

3. Underestimation of axial length in eyes with bullous rhegmatogeneous retinal detachment,

when optical biometry is performed

Axial length measurement in silicone oil filled eyes.

Biometry in silicone oil filled eyes is difficult to perform and an axial length measurement may
not be obtainable, when an ultrasound biometry is used for this purpose.

a) AL measurement in silicone filled eyes using ultrasound A scan biometry

Using ultrasound biometry for axial length measurement in silicone oil filled eyes has
several disadvantages. Silicone oil slows down the speed of sound and produces an
apparent lengthening of globe resulting in an longer Axial length 3,4 measurements. The
speed of sound in silicone oil [ for 1000 CSt silicone oil it is 980 m/s and 5000 CSt silicone
oil it is 1040m/s] much slower when compared to that in normal vitreous which is 1532
m/s.

The absorption of sound waves in silicone oil results in poor penetration further
impairing accurate measurements as the retinal echoes are low reflective.

Presence of an incomplete silicone oil fill may result in the presence of pooled
posteriorly circulating aqueous, when the axial length is measured in supine position. In
this situation the ultra sound waves will first traverse the SO filled vitreous cavity, the
silicone oil-aqueous interface followed by the pooled posteriorly circulated aqueous to
reach the retinal surface. Hence it is advisable to perform AL measurement with the
patient sitting up to so that most part of posterior pole is covered by the silicone oil
bubble.
 The axial length that is obtained using ultrasound biometer is the apparent axial length
and has to be converted into the true axial length making adjustment for the slow speed
of ultrasound waves in silicone oil.

b) Al measurement using optical biometry

The AL measurement in silicone oil filled eye is best accomplished using optical
coherence interferometey .The AL obtained is a true and accurate measurement as the
distance from cornea to the retinal pigment epithelium is measured.

Measurement in eyes with advanced/total cataract or a thick posterior sub capsular

lenticular opacity or if the patient cannot fixate is most challenging.

Axial length measurement in Silicone oil filled eyes was found to be more accurate using
Swept Source OCT in a few single centre studies with small sample sizes

The presence of silicone oil in the vitreous can appear to increase axial length and alter
the eye’s optics. Before the surgeon can calculate the correct IOL power, he or she must
convert the apparent axial length to a true measurement.

STEP: 1 Measuring the apparent AL is silicone oil filled eye.

To measure the vitreous cavity depth in an eye filled with silicone oil using the ultrasound
biometer, the velocity gate should be readjusted based on the viscosity of silicone oil
(1040m/s for 5000 CSt silicone oil and 980 m/s for 1000 CSt silicone oil)

STEP: 2 Converting apparent axial length to true axial length

(when A-scan is used)

Method :1 Using a Conversion Factor: The viscosities of silicone oils vary from 1000 CSt to
5000 CSt, and in general, the higher the viscosity, the greater the change in refraction and
axial length. If 1300 CSt silicone oil is used for semi-permanent tamponade, the apparent axial
length obtained using ultrasonic biometry can be converted to true axial length by multiplying
with a coversion factor (0.71)

TABLE: 1 Conversion factors are available for different tamponading agents

Type of silicone Conversion factor
Method: 2 Formula
Based Calculation:
SO 1000 0.63
The formula to convert
SO1300 0.71
axial length in eyes with
SO5000 0.36 silicone oil tamponade is as

Densiron 68 0.597
follows.

To calculate VCD converted

VCD converted = VCDSOx Velocity of sound in SO/Velocity of sound in normal Vitreous

TAL = Total axial length TAL= ACD + LT+ VCD converted

In situations where axial length measurement is not possible, by the method described above
any one of the following options may be resorted to

a. Axial length measurement carried out prior to the vitreoretinal surgery and archived in the
hospital records.

b. Using axial length of fellow eye( is not a very desirable option)

c. Intraoperative biometry for IOL power calculation at silicone oil removal .The biometry is
performed using a sterile probe after silicone oil removal and prior to cataract surgery.This
technique provide good predictability and reasonable accuracy and in various studies on
this technique the mean postoperative refractive error was only 0.77 D with no significant
difference in long eyes and eyes with average normal axial length.

d. Intraoperative retinoscopy for IOL power estimation in cases of combined phaco

emulsification and silicone oil removal, using theoretical formulas based on aphakic
refractive error. To calculate IOL power

The various formula that are available in the literature are

1. Lanchulev et al : Aphakic refraction x2.01

2. Mackool et al : Aphakic refraction x 0.75

3. Leccisolti et al :0.07 *(2)+1.27 X + 1.22 ,where X=Aphakic refraction

e. In cases with partial silicone oil fill, the axial length may be obtained from a CT image scan.

f. The least desirable option is to implant a STANDARD POWER IOL.

Accurate prediction of refractive outcomes in vitrectomized eyes is difficult due to multiple

factors. First, the absence of vitreous in the posterior segment can result in an unusually deep
and fluctuating anterior chamber, which increases the mobility of the posterior capsule and
intraocular lens (IOL) movement after surgery. Furthermore, the high risk of zonular weakness
and injury in vitrectomized eyes may lead to the instability of the lens capsular bag and
the misalignment of IOL. In addition, the replacement of the vitreous with aqueous humor or
silicone oil tamponade changes the refractive index of the posterior segment, which could
influence the accuracy of axial length (AL) measurement. A relatively higher percentage of
high myopia or staphylomatous eyes in this population also aggravates the inaccuracy of IOL
power calculation. And in all, these factors make it difficult to predict the accurate effective
lens position (ELP) and refractive outcomes for patients with previous PPV. Errors in axial
length measurement due to presence of macular thickening is also a reason for concern

Axial length measurement errors associated with vitrectomy for macular

diseases
With better understanding of the pathogenesis and clinical course of vitreoretinal interface
disorders (Diabetic macular edema, Macular holes, Vitreomacular traction, Epiretinal
membrane etc) more number of macular surgeries are performed and whenever required
these surgeries are usually combined with cataract extraction. This will ensure early visual
rehabilitation of patients with co-existing visually significant cataract and macular pathologies.

When these patients are being worked up preoperatively it is best to perform AL

measurement using an optical biometer as it takes into account the distance from the cornea
to the RPE. Most of these eye will have thickened and edematous macula and if an ultrasound
biometry is performed, the measured axial length will be erroneously short. In this situation
the corrected axial length is obtained by the following formula.

Corrected AL = Measured AL ( using ultrasound biometer A-Scan ) +Central foveal

thickness ( obtained from OCT scan)

Unless this correction is factored in, a postoperative myopic refractive surprise should be
expected due to the underestimation of the cornea- photo receptor layer( or RPE ) distance in
eyes with thickened maculas.

Several studies have shown that the actual value of this predicted myopic shift is 0.50 D and
hence if the corrected AL is not used for IOL Power calculations, it is prudent to use a slightly
hyperopic IOL in combined phacovitrectomy procedures.

Thus the myopic refractive shift after a combined single stage phacovitrectomy performed for
a vitreo-retinal interface pathology can be compensated by either of these two strategies.

1. Adding the central foveal thickness measurement on OCT to the ultrasound AL.

2. Implanting an IOL which has a power that is 0.50 D less than the IOL power targeted for
postoperative emmetropia.

The need to utilise these strategies does not arise if we resort to measuring the axial
length using the optical biometer.
Effect of GAS tamponade on the IOL position and its effect on refractive error
after phaco-vitrectomy and gas tamponade
Nobuhiko shiraki et al used Swept Source Anterior Segment OCT to calculate the aqueous
depth, lens thickness and the relative IOL position in eyes with gas tamponade. They reported
that even in eyes without gas tamponade a forward displacement of the IOL occurred at the
conclusion of the first postoperative month, relative to its position in the immediate
postoperative period. This forward movement was more in eyes with gas tamponade and
persisted to a lesser degree even after the gas filling the vitreous cavity got reabsorbed.The
forward movement of IOL pushed the lens iris diaphragm forward leading to a shallower
anterior chamber.Thus the myopic postoperative refractive shift can be attributed to 2 factors

➢ Anterior shift of the IOL

➢ Change in refractive index of the intra ocularmedium as the vitreous cavity gets filled by
posteriorly circulating aqueous after the intraocular gas has disappeared.

Errors in axial length measurement in eyes with previous scleral buckling

procedure
In eyes that have undergone scleral buckling procedures, there is a definite increase of the
axial length by nearly 1 mm, due to elongation of the back of the globe. This elongation of the
globe is not associated with any changes is the anterior chamber depth. Hence postoperatively
buckled eyes show a myopic refractive shift. The elongation of the AL stabilises by 3 months
after scleral buckling. 3600 scleral buckling in conjunction with use of adjunctive
cryoretinopexy is associated with greater axial length elongation.In a buckled eye, cataract
surgery is therefore usually delayed till atleast 3 month after the primary buckle surgery.
Taking into account the axial elongation of the globe following scleral buckle procedure, the
IOL power is adjusted down ( for IOL power > 14 D ) by 0.50 D. This rule is in corporated in the
Holladay constant also, where the IOL power we get on clicking the “ scleral buckled button ”
is one that has been adjusted down by 0.50 D.

Adjusting IOL power in silicone oil filled eyes

The refractive index of silicone oil (1.405) is higher than that of normal vitreous (1.336) and is
almost similar to that of the IOL (1.401).Because the index of refraction of silicone oil (1.405) is
higher than that of the vitreous gel, this optic medium behaves like an intraocular minus lens.
When the IOL power is not adjusted to account for this difference, standard theoretical and
regression lens power formulas predict a lens power that is less than needed to achieve
emmetropia. The result is significant postoperative hyperopic refractive error. As a rule of
thumb, the more power incorporated into the posterior surface of the chosen IOL, the greater
the postoperative error. When a patient with SO semipermanent tamponade has either a
primary or a secondary IOL implant, there is an increase in the refractive power of the
posterior surface of the IOL which is in contact with the silicone oil. The quantum of increase
in the refractive power of the implanted IOL is greatly influenced by the type of IOL used. It is
greatest with biconvex lens, least with meniscus lens and in between for plano convex lenses
with the plane surface facing posteriorly. Therefore if silicone oil tamponade is necessary for
an indefinitely long period of time (as determined by the stability of the retina) 3.00D - 8.00 D
should be added to the calculated IOL power (for emmetropic refraction) to compensate for
the alteration in the refractive power of the implanted IOL in silicone oil filled eye, with the
exact amount depending on the specific lens shape. With a convex-plano IOL, add 3.00 D to
the calculated IOL power; with a biconvex lens, add 6.00 D. Patients who will have the silicone
oil removed at a later date should be warned about the possibility of a myopic shift of 2.00 to
5.00 D. The shift will be greater for an eye with a biconvex lens than for an eye with a
planoconvex lens with a posteriorly facing planar surface; the smallest change occurs in eyes
with posterior-meniscus IOLs.

The additional power which should be added to the calculated IOL power can also be
determined using a formula (Patel et al 1995)

Additional power = {(NS-NV) / (ACD)} x 1000

[NS: Refractive index of silicone oil (1.405)

NV: Refractive index of vitreous (1.336)

AL: Axial length in millimetre

ACD: Anterior chamber depth]

Thus if silicone oil removal is performed in these eye at a later date a myopic shift is to be
expected. Hence proper patient counselling is a very important aspect, and should be taken
care of before planning surgery in these eyes.

Accuracy of IOL formula in combined phacovitrectomies was analysed and reported by

several authors by comparing preoperative optical biometry and postoperative outcomes. The
authors compared the prediction accuracy of new IOL calculation formulas [Barrett universal
11 ( BU11 ),emmetropia verifying optical( EVO), Kane and Ladas super formula ] and
traditional formulas [ Haigis, Hoffer Q , Holladay 1 and SRK/T ] with Wang-Koch axial length
adjustment in vitrectomised eyes.

The BU11, EVO, Kane and Haigis exhibited comparable performance in vitrectomised eyes
with optimized constants. In vitrectomised highly myopic eyes, the new formulas as well as
the traditional formulas with WK adjustment exhibited satisfactory prediction accuracy.
Silicone oil or intraocular gas tamponade did not affect the prediction accuracy of formulas
using optical biometry.

It is observed that in different categories of patients (vitrectomised eyes,eyes undegoing

combined phacoemulsification with IOL implantation and silicone oil removal or when
phacovitrectomy is performed as single stage procedure for vitreomacular interface
pathologies ) newer IOL formulas exhibited comparative or even better prediction accuracy
compared to traditional formulas. For highly myopic eyes with AL >26 mm applying the Wang
Koch axial length adjustment could correct the hyperopic bias of traditional formulas.

Choice of IOLs:In post-PPV eyes, hydrophobic and hydrophilic acrylic IOLs can have successful
outcomes. Rigid PMMA IOLs may also be considered; however, silicone IOLs should never be
implanted in vitrectomized eyes with silicone oil tamponade. This is also true for IOLs with a
one-piece plate haptic design and those with small and ovoid optics. Lenses with a 360º
square-edge design and an optic diameter of 6.0 to 6.5 mm provide greater area of fundus
visualization and, therefore, are preferable for patients with retinal pathology.

References
1. Cherfan GM, Michels RG, de Bustros S, Enger C, Glaser BM. Nuclear sclerotic cataract after
vitrectomy for idiopathic epiretinal membranes causing macular pucker. Am J Opthahlmol
1991; 111:434-438

2.Jackson TL, Nicod E, Angelis A, Grimaccia F, Prevost AT, Simpson ARH, Kanavos P. Pars
plana vitrectomy for vitreomacular traction syndrome: a systematic review and metaanalysis of
safety and efficacy. Retina. 2013; 33:2012-2017

3. Chang MA, Parides MK, Chang S, Braunstein RE. Outcome of phacoemulsification after
pars plana vitrectomy. Ophthalmol 2002; 109:948-954

4. Thompson JT. The role of patient age and intraocular gas use in cataract progression after
vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol 2004; 137:250-257

5. Biro Z, Kovacs B. Results of cataract surgery in previously vitrectomized eyes. J Cataract

Refract Surg 2002; 28:1003-1006

6. Titiyal JS, Agarwal E, Angmo D, Sharma M, Kumar A. Comparative evaluation of outcomes

of phacoemulsification in vitrectomized eyes: silicone oil versus air/gas group. Int Ophthalmol
2017; 37:565-574

7. Truscott RJ. Age-related nuclear cataract-oxidation is the key. Exp Eye Res 2005;80:709-725
8. Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the
lens: a possible mechanism for nuclear cataract formation. Am J Ophthalmol 2005; 139:302-
310

9. Elhousseini Z, Lee E, Williamson TH. Incidence of lens touch during pars plana vitrectomy
and outcomes from subsequent cataract surgery. Retina 2016; 36:825-829

10. Thomas L Lamson 1, Jane Song 2, Azin Abazari 2, Sarah B Weissbart 2. Refractive
outcomes of phacoemulsification after pars plana vitrectomy using traditional and new
intraocular lens calculation formulas. J Cataract Refract Surg. 2019 Mar;45(3):293-297

11.Vounotrypidis E, Haralanova V, Muth DR, Wertheimer C, Shajari M, Wolf A, Priglinger S,

Mayer WJ. Accuracy of SS-OCT biometry compared with partial coherence interferometry
biometry for combined phacovitrectomy with internal limiting membrane peeling. J Cataract
Refract Surg. 2019 Jan; 45(1):48-53

12. T Olsen Sources of error in intraocular lens power calculation J Cataract Refract Surg
1992 Mar;18(2):125-9.
 

13. J R McEwan, R K Massengill, S D Friedel

Effect of keratometer and axial length measurement errors on primary implant power calcula-
tions J Cataract Refract Surg 1990 Jan;16(1):61-70

14. D C Murray 1, T Potamitis, P Good, G R Kirkby, M T Benson Biometry of the silicone oil-
filled eye Eye (Lond) 1999 Jun;13 ( Pt 3a):319-24.

15. Piotr Kanclerz 1, Andrzej Grzybowski 2 3. Accuracy of Intraocular Lens Power

Calculation in Eyes Filled with Silicone Oil. Semin Ophthalmol. 2019; 34(5):392-397

16. Pongsachareonnont P, Tangjanyatam S  Accuracy of axial length measurements obtained by

optical biometry and acoustic biometry in rhegmatogenous retinal detachment: a prospective
study. Dovepress 23 May 2018 Volume 2018:12 Pages 973—980

17. Hoffer KJ. Special circumstances silicone oil power. In: Hoffer Kennneth J, editor. Iol
power. Thorofare: SLACK; 2011. 221-222

18. Hoffer KJ. Ultrasound velocities for axial eye length measurement. J Cataract Refract Surg
1994; 20:554-562

19. M A Rehman Siddiqui 1, M Amer Awan, Andrew Fairhead, Hatem Atta. Ultrasound
velocity in heavy ocular tamponade agents and implications for biometry. Br J Ophthalmol .
2011 Jan; 95(1):142-144

20. Murray DC, Potamitis T, Good P, et al. Biometry of the silicone oil-filled eye. Eye 1999;
13:319-324
21.Takei K, Sekine Y, Okamoto F, Hommura S. Measurement of axial length of eyes with
incomplete filling of silicone oil in the vitreous cavity using x ray computed tomography. Br J
Ophthalmol. 2002; 86(1):47-50

22.Hammouda Hamdi Ghoraba 1, Alaa Amer El-Dorghamy, Ahmed Fahmy Atia, Abd El-Aziz
Ismail Yassin. The problems of biometry in combined silicone oil removal and cataract
extraction: a clinical trial. Retina. 2002 Oct; 22(5):589-596

23 .Samir Mohamed El-Baha 1, Tarek Samir Hemeida Comparison of refractive outcome using
intraoperative biometry and partial coherence interferometry in silicone oil-filled eyes. Retina.
2009 Jan; 29(1):64-68

24. Mana Tehrani 1, Frank Krummenauer, Eric Blom, H Burkhard Dick. Evaluation of the
practicality of optical biometry and applanation ultrasound in 253 eyes. J Cataract Refract
Surg . 2003 Apr; 29(4):741-746

25. Piotr Kanclerz 1, Andrzej Grzybowski 2 3. Accuracy of Intraocular Lens Power Calculation
in Eyes Filled with Silicone Oil. Semin Ophthalmol. 2019; 34(5):392-397

26. 26. D C Murray 1, O M Durrani, P Good, M T Benson, G R Kirkby

Biometry of the silicone oil-filled eye: II
Eye (Lond) 2002 Nov;16(6):727-30.

27. Hoffer KJ: Ultrasound velocities for axial length measurement. J Cataract Refract Surg
1994; 20: 554

28. Kunavisarut P, Poopattanakul P, Intarated C, Pathanapitoon K. Accuracy and reliability of

IOL master and A-scan immersion biometry in silicone oil-filled eyes. Eye (Lond) 2012;
26(10):1344-1348

29. Amal M Elbendary 1, Mohamed M Elwan.Predicted versus actual intraocular lens power in
silicon-oil-filled eyes undergoing cataract extraction using automated intraoperative
retinoscopy. Curr Eye Res. 2012 Aug;37(8):694-697

30. 30. Ianchulev T, Salz J, Hoffer K, Albini T, Hsu H, Labree L.J Cataract Refract Surg. 2005
Aug;31(8):1530-6. doi: 10.1016/j.jcrs.2005.01.035.

31. Richard J Mackool Intraoperative retinoscopy J Cataract Refract Surg. 2006 Apr;32(4):548-

9.  doi: 10.1016/j.jcrs.2006.01.019.

32. Sourabh D Patwardhan 1, Rajvardhan Azad, Yograj Sharma, Bhuvan Chanana, Jaideep

Tyagi Intraoperative retinoscopy for intraocular lens power estimation in cases of combined
phacoemulsification and silicone oil removal J Cataract Refract Surg 2009 Jul;35(7):1190-2.
33. . Kazuo Takei, Yasuo Sekine, Fumiki Okamoto, Sachiko Hommura
Measurement of axial length of eyes with incomplete filling of silicone oil in the vitreous cav-
ity using x ray computed tomography.
Br J Ophthalmol 2002;86:47–50

34. Kanclerz P, Grzybowski A, Schwartz SG, Lipowski P. Complications of cataract surgery in

eyes filled with silicone oil. Eur J Ophthalmol. 2018;28(4):465–468. [PubMed] [Google
Scholar]
35. Hoffer KJ. The Hoffer Q formula: a comparison of theoretic and regression formulas. J
Cataract Refract Surg. 1993;19(6):700–712. [PubMed] [Google Scholar]
36. Suk KK, Smiddy WE, Shi W. Refractive outcomes after silicone oil removal and intraocular
lens implantation. Retina. 2013;33(3):634–641. [PubMed] [Google Scholar]
37. Kanclerz P, Grzybowski A. Accuracy of intraocular lens power calculation in eyes filled
with silicone oil. Semin Ophthalmol. 2019;34(5):392–397

38. Andreas Frings 1, Simon Dulz, Christos Skevas, Birthe Stemplewitz, Stephan J Linke, Gis-

bert Richard, Lars Wagenfeld Postoperative refractive error after phacovitrectomy for epireti-
nal membrane with and without macular oedema Graefes Arch Clin Exp Ophthalmol 2015
Jul;253(7):1097-104. doi: 10.1007/s00417-015-2948-8. Epub 2015 Feb 6.

39. Gülkilik G, Erdur S, Özbek M, Özsütcü M, Adabasi M, Demirci G, Kocabora M, Eliacik M

(2016) Changes in anterior chamber depth after combined phacovitrectomy. Turk J Ophthalmol
46:161-164

40. Nobuhiko Shiraki , Taku Wakabayashi , Hirokazu Sakaguchi , Kohji Nishida . Effect of Gas
Tamponade on the Intraocular Lens Position and Refractive Error after Phacovitrectomy: A
Swept-Source Anterior Segment OCT Analysis. Ophthalmology. 2020 Apr; 127(4):511-515

41. Kelly D Schweitzer, Raúl García.Myopic shift after combined phacoemulsification and
vitrectomy with gas tamponade. Can J Ophthalmol. 2008 Oct; 43(5):581-583

42. Shira Sheen Ophir, Asaf Friehmann, Alexander Rubowitz. Circumferential silicone sponge
scleral buckling induced axial length changes: case series and comparison to literature. Int J
Retina Vitreous. 2017 Mar 27;3:10

43. Lee DH, Han JW, Kim SS, Byeon SH, Koh HJ, Lee SC, Kim M. Long-term Effect of
Scleral Encircling on Axial Elongation. Am J Ophthalmol. 2018 May;189:139-145

44.Tan X, Zhang J, Zhu Y, Xu J, Qiu X, Yang G, Liu Z, Luo L, Liu Y. Accuracy of New
Generation Intraocular Lens Calculation Formulas in Vitrectomized Eyes. Am J Ophthalmol.
2020 Sep; 217:81-90

45. Piotr Kanclerz 1, Andrzej Grzybowski 2

Accuracy of Intraocular Lens Power Calculation in Eyes Filled with Silicone Oil Semin Oph-
thalmol 2019;34(5):392-397.

46. Patel AS. IOL power selection for eyes with silicone oil used as vitreous replacement. Ab-
stract #163. Symposium on Cataract and Refractive Surgery, April 1–5, San Diego, California,
1995;41.
47.Leonie J van der Geest , Martin J Siemerink 1, Marco Mura , Maarten P Mourits , Ruth
Lapid-Gortzak 2.Refractive outcomes after phacovitrectomy surgery. J Cataract Refract Surg.
2016 Jun; 42(6):840-845

Kunavisarut P, Poopattanakul P, Intarated C, Pathanapitoon K.

Accuracy and reliability of IOL master and A-scan immersion biometry in silicone oil-filled eyes. Eye

(Lond). 2012;26:1344–1348

28
33. Intraoperative optical refractive biometry for intraocular lens power estimation
without axial length and keratometry measurements.
30. Ianchulev T, Salz J, Hoffer K, Albini T, Hsu H, Labree L.J Cataract Refract Surg. 2005
Aug;31(8):1530-6. doi: 10.1016/j.jcrs.2005.01.035.

31. Richard J Mackool Intraoperative retinoscopy J Cataract Refract Surg. 2006

Apr;32(4):548-9.  doi: 10.1016/j.jcrs.2006.01.019.

32. Sourabh D Patwardhan 1, Rajvardhan Azad, Yograj Sharma, Bhuvan

Chanana, Jaideep Tyagi Intraoperative retinoscopy for intraocular lens power estimation in cases of
combined phacoemulsification and silicone oil removal J Cataract Refract Surg 2009
Jul;35(7):1190-2.
33. . Kazuo Takei, Yasuo Sekine, Fumiki Okamoto, Sachiko Hommura
Measurement of axial length of eyes with incomplete filling of silicone oil in the vitreous cav-
ity using x ray computed tomography.
Br J Ophthalmol 2002;86:47–50
34. Kanclerz P, Grzybowski A, Schwartz SG, Lipowski P. Complications of cataract
surgery in eyes filled with silicone oil. Eur J Ophthalmol. 2018;28(4):465–
468. [PubMed] [Google Scholar]
35. Hoffer KJ. The Hoffer Q formula: a comparison of theoretic and regression for-
mulas. J Cataract Refract Surg. 1993;19(6):700–712. [PubMed] [Google Scholar]
36. Suk KK, Smiddy WE, Shi W. Refractive outcomes after silicone oil removal and
intraocular lens implantation. Retina. 2013;33(3):634–641. [PubMed] [Google
Scholar]
37. Kanclerz P, Grzybowski A. Accuracy of intraocular lens power calculation in
eyes filled with silicone oil. Semin Ophthalmol. 2019;34(5):392–397

38. Andreas Frings , Simon Dulz, Christos Skevas, Birthe Stemplewitz, Stephan J

 1

Linke, Gisbert Richard, Lars Wagenfeld Postoperative refractive error after phacovitrectomy for

epiretinal membrane with and without macular oedema Graefes Arch Clin Exp Ophthalmol 2015
Jul;253(7):1097-104. doi: 10.1007/s00417-015-2948-8. Epub 2015 Feb 6.

44. Piotr Kanclerz 1, Andrzej Grzybowski 2

Accuracy of Intraocular Lens Power Calculation in Eyes Filled with Silicone Oil Semin Ophthalmol
2019;34(5):392-397.

45. Patel AS. IOL power selection for eyes with silicone oil used as vitreous re-
placement. Abstract #163. Symposium on Cataract and Refractive Surgery,
April 1–5, San Diego, California, 1995;41.