B. Seitz et al., Underestimation of intraocular lens power for cataract surgery after myopic photorefractive keratectomy, OPHTHALMOL, 106(4), 1999, pp. 693-702
Objective: To assess the validity of corneal power measurement and standard
intraocular lens power (IOLP) calculation after photorefractive keratectom
y (PRK).
Design: Nonrandomized, prospective, cross-sectional, clinical study.
Participants: A total of 31 eyes of 21 females and 10 males with a mean age
at the time of surgery of. 32.3 +/- 6.6 years (range, 24.4-49.5 years).
Intervention: Subjective refractometry, standard keratometry, TMS-1 corneal
topography analysis, and pachymetry were performed before and 15.8 +/- 10.
4 months after PRK for myopia (n = 24, -1.5 to -8.0 diopters [D], mean -5.4
+/- 1.9 D) or myopic astigmatism (n = 7, sphere -2.0 to -7.5 D, mean -4.4
+/- 1.9 D; cylinder -1.0 to -3.0 D, mean -1.9 +/- 0.7 D). The IOLP calculat
ions were done using two different formulas (SRK/T and HAIGIS).
Main Outcome Measures: Keratometric power (K) and topographic simulated ker
atometric power (TOPO) as measured (K-meas, TOPOmeas) and as calculated acc
ording to the change of power of the anterior corneal surface or according
to the spherical equivalent change after PRK (K-calc, TOPOcalc), IOLP for e
mmetropia, and postoperative ametropia for calculated corneal powers were a
ssessed in a model.
Results: After PRK, mean K-meas and TOPOmeas were significantly greater (0.
4-1.4 D, maximum 3.3 D) than mean KRcalc and TOPOcalc (P < 0.0001). On aver
age, the relative flattening of the cornea after PRK was underestimated by
14% to 30% (maximum, 83%) depending on the method of calculation. The mean
theoretical IOLP after PRK ranged from + 17.4 D (SRK/T, TOPOmeas) to +20.9
D (HAIGIS, K-calc) depending on the calculation method for corneal power an
d IOLP calculation formula used. For both formulas, IOLP values using kerat
ometric readings were significantly higher (>1 D) than IOLP values using to
pographic readings (P < 0.0001). The theoretically induced mean refractive
error after cataract surgery ranged from +0.4 to +1.4 (maximum, +3.1) D. Co
rneal power overestimation and IOLP underestimation correlated significantl
y with the spherical equivalent change after PRK (P = 0.001) and the intend
ed ablation depth during PRK (P = 0.004).
Conclusions: To avoid underestimation of IOLP and hyperopia after cataract
surgery following PRK, measured corneal power values must be corrected. The
calculation method using spherical equivalent change of refraction at the
corneal plane seems to be the most appropriate method. In comparison with t
his method, direct power measurements underestimate corneal flattening afte
r PRK by 24% on average. Use of conventional topography analysis seems to i
ncrease the risk of error. However, because this study is retrospective and
theoretical, there is still a need for a large prospective investigation t
o validate the authors' findings.