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. 2025 Mar 18;18(3):518-525.
doi: 10.18240/ijo.2025.03.20. eCollection 2025.

Effect of pharmacological pupil changes on intraocular lens power calculation: a systematic review and Meta-analysis

Si-Yi Tan  1 , Dian-Feng Liu  1 , Wei-Qi Wang  1 , Bing-Song Wang  1
Affiliations

Effect of pharmacological pupil changes on intraocular lens power calculation: a systematic review and Meta-analysis

Si-Yi Tan et al. Int J Ophthalmol. .

Abstract

Aim: To investigate the effect of pharmacological pupil alterations on intraocular lens (IOL) power calculations.

Methods: A systematic review and Meta-analysis of studies published before December 2023 in the PubMed, Embase, and Cochrane library databases on the accuracy of pharmacological pupil changes on IOL power calculation was performed. The primary outcome was the results of IOL power calculations before and after the use of medications. Subgroup analyses were performed based on participants' basic characteristics, such as age, axial length (AL), and whether miosis or mydriasis were used as classification criteria for further analyses. Each eligible study was evaluated for potential risk of bias by the AHRQ assessment scale. The study was registered on PROSPERO (CRD 42024497535).

Results: A total of 3062 eyes from 21 studies were eligible. There was no significant difference in the IOL power calculation before and after pharmacological pupil changes using any of the Hoffer Q (WMD=0.055, 95%CI=-0.046-0.156; P=0.29), SRK/T (WMD=0.003, 95%CI=-0.073-0.080; P=0.93), Haigis (WMD=-0.030, 95%CI=-0.176-0.116; P=0.69), Holladay 2 (WMD=-0.042, 95%CI=-0.366-0.282; P=0.80), and Barrett Universal II (WMD=0.033, 95%CI=-0.061-0.127; P=0.49) formulas. On the measurement of parameters related to IOL power calculation, for either miosis or mydriasis AL (P=0.98 and 0.29, respectively), lens thickness (P=0.96 and 0.13, respectively), and mean keratometry (P=0.90 and 0.86, respectively) did not present significant differences, while anterior chamber depth (P=0.07 and <0.01, respectively) and white-to-white distance (P=0.01 and 0.04, respectively) changed significantly between the two measurements prior and posterior. At the same time, despite there being some participants with the difference between the before and after calculations greater than 0.5 diopter, there was no significant difference in the incidence rate between these formulas.

Conclusion: There is no significant effect of pharmacological pupil changes on the IOL power calculation. It will considerably reduce the visit time burden for patients who require cataract surgery.

Keywords: cataract; intraocular lens; ocular biometry; pharmacological pupil alterations; power calculation.

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Conflict of interest statement

Conflicts of Interest: Tan SY, None; Liu DF, None; Wang WQ, None; Wang BS, None.

Figures

Figure 1
Figure 1. Flow chart of study selection.
Figure 2
Figure 2. Forest plots for WMD of IOL power calculation before and after pharmacological pupil changes
WMD: Weighted mean difference; IOL: Intraocular lens.
Figure 3
Figure 3. Forest plots for IOL power calculation error more than 0.5 D before and after pharmacological pupil changes
IOL: Intraocular lens.
Figure 4
Figure 4. Funnel plots for WMD of IOL power calculation (A) and IOL power calculation error more than 0.5 D (B) before and after pharmacological pupil changes
WMD: Weighted mean difference; IOL: Intraocular lens.
See this image and copyright information in PMC

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