title: First clinicial results on the feasibility, quality and reproducibility of aberrometry-based intraoperative refraction during cataract surgery.
abstract: OBJECTIVE
  To provide the first clinical data in determining the feasibility, quality and precision of intraoperative wavefront aberrometry (IWA)-based refraction in patients with cataract.
  
  
  METHODS
  IWA refraction was recorded at 7 defined measurement points during standardised cataract surgery in 74 eyes of 74 consecutive patients (mean age 69±11.3 years). Precision and measurement quality was evaluated by the 'limits of agreement' approach, regression analysis, correlation analysis, Analysis of variance (ANOVA) and ORs for predicting measurement failure. Wavefront map (WFM) quality was objectivised and compared with the Pentacam Nuclear Staging analysis.
  
  
  RESULTS
  Out of 814 IWA measurement attempts, 462 WFMs could be obtained. The most successful readings (n=63) were achieved in aphakia with viscoelastic. The highest (50.63%, SD 20.23) and lowest (29.19%, SD 13.94) quality of WFMs across all measurement points were found after clear corneal incision and in pseudophakia with viscoelastic, respectively. High consistency across repeated measures were found for mean spherical equivalent (SE) differences in aphakia with -0.01D and pseudophakia with -0.01D, but ranges were high (limits of agreement +0.69 D and -0.72 D; +1.53 D and -1.54 D, respectively). With increasing WFM quality, higher precision in measurements was observed.
  
  
  CONCLUSIONS
  This is the first report addressing quality and reproducibility of WA in a large sample. IWA refraction in aphakia, for instance, appears to be reliable once stable and pressurised anterior chamber conditions are achieved. More efforts are required to improve the precision and quality of measurements before IWA can be used to guide the surgical refractive plan in cataract surgery.
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany South West Peninsula Postgraduate Medical Education, School of Ophthalmology, Plymouth, UK.
authors.forename: Jan O
authors.initials: JO
authors.lastname: Huelle
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany Care Vision, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Toam
authors.initials: T
authors.lastname: Katz
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Vasyl
authors.initials: V
authors.lastname: Druchkiv
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Milena
authors.initials: M
authors.lastname: Pahlitzsch
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Steinberg
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Gisbert
authors.initials: G
authors.lastname: Richard
authors.affiliation: Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany Care Vision, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Linke
mesh_terms: D057128:Aberrometry / Q000379:methods*; D000368:Aged; D001035:Aphakia / Q000503:physiopathology; D002387:Cataract Extraction; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology; D012029:Refraction, Ocular / Q000502:physiology*; D015203:Reproducibility of Results; D014792:Visual Acuity / Q000502:physiology*
keywords: Clinical Trial; Diagnostic tests/Investigation; Optics and Refraction