Intraocular lens power calculation in patients with corneal ablative treatments or corneal pathologies: perspective
Keywords:Corneal surgery, laser, Fuchs’ endothelial dystrophy, Keratectomy, Keratoconus
Intraocular lens power calculation in patients with abnormal corneas secondary to ablative treatments or pathologies is challenging. The historical data methods, which collect data before corneal ablative treatment, are preferred for the intraocular lens power calculation. It is recommended to perform the calculation with several formulas and to compare the calculated lens powers. The Barrett True-K (total keratometry) provides good prediction after myopic and hyperopic laser treatment. In general, a mild myopia should be aimed for, and aspheric lenses are preferred in these cases. The corneal irregularity in patients with keratoconus necessitates measurements of the back surface of the cornea. Postoperative myopia should be aimed for owing to the risk of hyperopic refractive outcomes. Implantation of toric lenses is only recommended in selected cases. In patients with Fuchs’ endothelial dystrophy, preoperative measurements should be performed after administration of hyperosmolar eye drops and as late as possible during the course of the day. Measurements should include the posterior corneal surface. Owing to the hyperopic shift after Descemet membrane endothelial keratoplasty or Descemet stripping automated endothelial keratoplasty, a slight myopia should be aimed for, followed by cataract surgery in future. In exceptional cases, the implantation of toric lenses may be considered.
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