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No-history methods to calculate intraocular lens power in eyes with previous myopic laser refractive surgery: a network meta-analysis

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First Author: J.Huang CHINA

Co Author(s):    D. Wen   J. Yu   C. McAlinden   Q. Wang           

Abstract Details


To systematically compare and rank the predictability of no-history intraocular lens (IOL) power calculation methods after myopic laser refractive surgery.


Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.


PubMed, Embase, the Cochrane Library and the US trial registry ( were used to systematically search trials published up to August 2019. We included case series studies reporting the following outcomes in patients undergoing phacoemulsification cataract surgery after laser refractive surgery: percentage of eyes with a refractive prediction error (PE) within ±0.50 diopters (D) and ±1.00 D, mean absolute error (MAE) and median absolute error (MedAE). A network meta-analysis was conducted using the STATA version 13.1.


Nineteen studies involving 1098 eyes and 19 formulas were identified. A network meta-analysis for the percentage of eyes with a PE within ±0.50 D found that ray-tracing (Okulix), intraoperative aberrometry (Optiwave Refractive Analysis, ORA), BESSt and Seitz/Speicher/Savini (Triple-S) methods (with Double-K SRK/T) and the Fourier-Domain OCT-Based formula were more predictive than the Wang/Koch/Maloney method, Shammas-PL formula, modified Rosa’s formula, Ferrara’s method and Equivalent K reading (EKR) at 4.5 mm using the Double-K Holladay 1 formula. With regards to ranking, the top four formulas as per the surface under the cumulative ranking curve (SUCRA) values for the percentage of eyes with a PE within ±0.50 D were the Okulix, ORA, BESSt and Triple-S methods. With regards the MAE, the ORA showed lower errors when compared to the Shammas-PL method. In this regard, the top four methods, based on the SUCRA values, were the Triple-S, BESSt, ORA and the Fourier-Domain OCT-Based formula. The SToP (SRK/T) formula, ORA, Fourier-Domain OCT-Based formula and BESSt method had the lowest MedAE.


Considering all three outcome measures of highest percentages of eyes with a PE within ±0.50 and ±1.00 D, lowest MAE and lowest MedAE, the top three formulas were: ORA, BESSt and Triple-S (with Double-K SRK/T).

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