Purpose This study aimed to investigate the relationship between high intraocular pressure (IOP) effect on axial length (AL) and postoperative refractive error after cataract surgery. Methods A retrospective study was conducted on cases that underwent cataract surgery for elevated IOP. AL was corrected based on the change in AL per 1 mmHg of IOP, and the predicted refractive error was evaluated at 3 months postoperatively. Preoperative and postoperative optical biometry was performed using the segmented refractive index method. Intraocular lens (IOL) power was calculated using both the SRK/T and Barrett Universal II (BU II) formulas. Results Optical biometry was obtained in 18 cases and 19 eyes before and after cataract surgery. A moderate correlation was observed between the change in IOP and AL (r = 0.687, P = 0.0012), with the change in AL per 1 mmHg of reduction in IOP calculated as 0.005 mm. The mean change in IOP was 38.87 ± 10.80 mmHg (P = 0.001), and the AL \ significantly shortened by 0.18 ± 0.09 mm (P = 0.001). The mean postoperative refractive errors were 0.36 ± 0.59 D with the SRK/T formula, 0.79 ± 0.58 D with the BU II formula, showing significantly more hyperopia (p = 0.001). After AL correction, the predicted refractive error was reduced to −0.08 ± 0.54 D (SRK/T) and 0.27 ± 0.55 D (BU II). Conclusions In cataract surgery for eyes with elevated IOP, using corrected AL based on the anticipated IOP reduction appears to decrease the predicted refractive error. Additionally, it should be noted that the BU II formula may result in a hyperopic shift in refractive prediction error, even when using the adjusted AL.
Kosaka et al. (2026) studied this question.