Changes in Axial Length and Refractive Error After Noninvasive Normalization of Intraocular Pressure From Elevated Levels

Purpose To explore the changes in axial length and refractive error after noninvasive normalization of intraocular pressure (IOP) from elevated levels. Design A prospective observational study. Methods We enrolled 51 consecutive patients with abnormally elevated unilateral IOP (≥10 mm Hg compared with that of the fellow eye, in which the IOP was ≤21 mm Hg). In all patients, the keratometric value and axial length were obtained with the aid of an IOLMaster before and after IOP normalization (defined as attainment of an IOP difference of ≤3 mm Hg compared with the fellow eye, with or without topical application of ocular hypotensive therapy). We focused principally on IOP, axial length, the keratometric value, and the predicted refractive difference (the predicted refractive error after IOP normalization upon placement of an IOL with a power for emmetropia correction determined prior to IOP normalization). Results The axial length was significantly reduced from 23.5 to 23.3 mm after IOP normalization, from 45.9 mm Hg to 14.3 mm Hg ( P < .001). The change in IOP correlated with that of the axial length (r = 0.826, P < .001), but not with the change in the keratometric value ( P = .618). The change in axial length per 10 mm Hg IOP decrease was −0.06 mm ( P < .001). The IOP change was correlated with the predicted refractive difference (r = 0.693, P < .001); the predicted refractive difference per 10 mm Hg IOP decrease was +0.15 diopter ( P < .001). Conclusions The axial length decreased and the predicted refractive difference increased (hyperopia) as IOP decreased. Therefore, a possible risk of postoperative hyperopic shift should be considered when biometric examination for IOL power calculation is performed in a patient with an abnormally elevated IOP.