Network Meta-analysis of Intraocular Lens Power Calculation Formula Accuracy in 1016 Eyes With Long Axial Length

PURPOSE To systematically review the literature and quantitatively synthesize the currently available evidence to compare the accuracy of different intraocular lens calculation formulas in eyes with long axial length (AL). DESIGN Network meta-analysis. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for studies published between January 2000 and June 2022. Included were prospective or retrospective clinical studies reporting the following outcomes in cataract patients with long AL (AL ≥ 26 mm): percentage of eyes with a prediction error (PE) within ±0.25, ±0.50 and ±1.00 diopters (D). Network meta-analysis was conducted using R software (version 4.2.1). RESULTS 10 prospective or retrospective clinical studies, including 1016 eyes and 11 calculation formulas, were identified. A traditional meta-analysis showed that for the percentage of eyes with PE within ±0.25 D and ±0.50 D, the Olsen, Kane and Emmetropia Verifying Optical (EVO) all had insignificantly higher percentages compared to others. Considering the percentage of eyes with PE within ±1.00 D, the original and modified Wang-Koch adjustment formulas for Holladay 1 (H1-WK and H1-MWK) and EVO formulas showed superiority, but the difference was insignificant. This network meta-analysis revealed that compared with the widely used Barrett Universal II (BUII) formula, the Olsen, Kane and EVO formulas had higher percentages of eyes with PE within ±0.25 D, ±0.50 D and ±1.00 D (all OR > 1 but P > 0.05). Based on the surface under the cumulative ranking area (SUCRA) values for the percentage of eyes with PE within ±0.25 D, the Olsen (96.4%), Kane (77.5%) and EVO (75.9%) formulas had the highest probability of being in the top three of the 11 formulas. CONCLUSIONS The Olsen, Kane and EVO formulas may perform better than others in calculating IOL power in eyes with long AL. Nevertheless, there is still considerable uncertainty in this regard and the accuracy of these formulas in highly myopic eyes should be confirmed in studies based on large multicenter registries.