Optimizing axial length measurement success in advanced cataract patients through pupil dilation.

PURPOSE: To evaluate the impact of pharmacologic pupil dilation on axial length (AL) measurement in patients with dense cataracts and previous failed AL measurements carried out without pupil dilation.

DESIGN

Retrospective case series.

METHODS

All participants underwent swept-source optical coherence tomography (SS-OCT) biometry. Patients with unsuccessful AL measurements due to dense cataract underwent an additional SS-OCT biometric evaluation after pupil dilation, and the SS-OCT AL measurement was compared to the immersion ultrasound.

RESULTS

The study included 3668 eyes of 3668 patients who underwent SS-OCT between October 2021 and March 2023. Of them, 102 eyes (2.8%) had failed AL measurements because of dense cataract. Eighty-seven of those 102 eyes underwent a repeat SS-OCT biometric exam following pharmacologic pupil dilation, after which AL measurements were successfully achieved in 27 (31.0%) of the 87 eyes. These measurements were found to be consistent with immersion ultrasound, supporting the validity of SS-OCT biometer measurements post dilation.

CONCLUSIONS

Pharmacologic pupil dilation improved the rate of successful SS-OCT biometrically measured AL in patients with failed AL measurement due to dense cataract.