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Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study

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Abstract

Purpose

To analyze the impact of axial length (AL) on the visual outcome and rate of perioperative complications in phacoemulsification surgery.

Design

Retrospective clinical database study.

Methods

Cataract surgery data of 217,556 eyes was extracted from the electronic medical records of 8 ophthalmic centers in the United Kingdom from July 2003 to March 2015. A total of 88,774 eyes without ocular co-pathologies were grouped eyes according to AL (mm): short AL (< 22), average AL (22–26; reference group), and long AL (> 26).

Main outcomes and measures

We analyzed visual acuity (VA) outcomes at 4 weeks, 4–12 weeks, and 12–24 weeks postoperatively, as well as the incidence of posterior capsular rupture (PCR), torn iris (TI), cystoid macular edema (CME), and retinal detachment (RD).

Results

Mean pre-operative VA (logMAR) was the worst in eyes with long AL compared to average and short AL eyes (VA 0.59 vs. 0.58 and 0.56; p < 0.001). However, post-operative VA at 4–12 weeks was slightly better in the long AL group (0.14 in short and average AL; 0.12 in long AL, p < 0.001). We observed an increased odds of TI in the short AL group (OR 2.09, 95% CI 1.60–2.75). There was increased risk of RD in long AL eyes (p < 0.001). However, PCR and CME rates were not different.

Conclusion

In the absence of any coexisting ocular pathology, AL alone did not have an impact on VA improvement or the risk of encountering PCR or CME. The risk of TI was greater in the short AL group, and the risk of RD was higher in the long AL group.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

We have no financial disclosures, and this project did not receive any funding.

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Authors and Affiliations

  1. Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72207, USA

    Kinza T. Ahmad, Muhammad Z. Chauhan, Abdelrahman M. Elhusseiny & Ahmed B. Sallam

  2. Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt

    Mohamed K. Soliman

  3. Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom

    Yit C. Yang

  4. Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom

    Ahmed B. Sallam

Authors
  1. Kinza T. Ahmad
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  2. Muhammad Z. Chauhan
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  4. Abdelrahman M. Elhusseiny
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  5. Yit C. Yang
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Contributions

Conception and design: Yang, Soliman, Elhusseiny, and Sallam.

Analysis and interpretation: Chauhan, Elhusseiny, Soliman, and Sallam.

Data collection: Yang and Sallam.

Writing the manuscript: Ahmad, Soliman, and Elhusseiny.

Corresponding author

Correspondence to Ahmed B. Sallam.

Ethics declarations

Ethics approval and consent to participate

Approval for data extraction was provided by the lead clinician at each center and the Caldicott Guardian, who oversees data protection. The extracted patient information was de-identified and therefore was not classified as human subject research and informed consent from patients was not required.

The study was conducted under Health Insurance Portability and Accountability Act (HIPAA) compliance and adhered to the tenets of the Declaration of Helsinki.

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Not applicable.

Competing interests

The authors declare that there is no conflict of interest regarding the publication of this paper.

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Ahmad, K.T., Chauhan, M.Z., Soliman, M.K. et al. Impact of axial length on visual outcomes and complications in phacoemulsification surgery: a multicenter database study. Graefes Arch Clin Exp Ophthalmol 261, 3511–3520 (2023). https://doi.org/10.1007/s00417-023-06120-2

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  • DOI: https://doi.org/10.1007/s00417-023-06120-2

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