de Rojas Silva Mª Victoria, Tobío Ruibal Adrián, Suanzes Hernández Jorge, Darriba Folgar Hugo
Victoria de Rojas Instituto Oftalmológico - Policlínica Assistens, Grupo Ribera, A Coruña, Spain.
Department of Ophthalmology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
Graefes Arch Clin Exp Ophthalmol. 2025 Mar;263(3):873-881. doi: 10.1007/s00417-024-06661-0. Epub 2024 Oct 10.
To evaluate and compare the predictability of five methods of intraocular lens (IOL) calculation in eyes with prior keratorefractive lenticule extraction (KLEx) for the treatment of myopia.
A retrospective case study included 100 eyes of 52 patients who underwent myopia and myopia with astigmatism treatment with small incision lenticule extraction (SMILE). Preoperative and 3-month postoperative measurements of optical biometry and corneal tomography were obtained. The spherical equivalent of the refractive change induced by surgery was converted to the corneal plane (SMILE-dif). A physically well-defined method was developed in which the same IOL model was implanted before and after SMILE. IOL power was calculated using ray-tracing (RT-Sirius), and several IOL power calculation formulas (Kane, EVO 2.0, Barrett Universal II Formula, Hoffer QST) before surgery. After surgery, IOL power was calculated with RT-Sirius, Kane using Mean Pupil Power at 5.5 mm by ray tracing, EVO 2.0 Post Myopic LASIK/PRK, Barrett True K and Hoffer QST Post Myopic LASIK/PRK after surgery. The difference between the refractive error induced by the IOL before and after SMILE in the corneal plane (IOL-dif) was compared with SMILE-dif. The predicted error (PE) was calculated as the difference between SMILE-dif and IOL-dif.
The PE obtained was 0.26 ± 0.55 diopters (D), 0.10 ± 0.45 D, 0.40 ± 0.37 D, -0.03 ± 0.36 D, 0.02 ± 0.51 D, with RT-Sirius, Kane, EVO 2.0, Barrett True K, and Hoffer QST respectively. PE was not statistically significantly different between Barrett True K and Hoffer QST, with differences being more homogeneous with Barrett, (variance σ = 0,13). The absolute EP obtained with Barrett True K achieved 84% of cases within ± 0.5 D, followed by Kane (72%), Hoffer QST (65%), EVO (61%) and RT-Sirius (59%).
Barrett True K formula was the most accurate method for IOL calculation in eyes that had undergone SMILE for the correction of myopia.
What is known The literature regarding IOL power calculation after SMILE is sparse, and the methods used to estimate corneal power following LASIK/PRK may not be applicable to SMILE procedures. The most common approach to investigating the predictability of IOL calculation formulas involves a theoretical model encompassing the virtual implantation of an IOL. What is new The Hoffer QST formula, Kane formula using Mean Pupil Power at 5.5 mm, EVO 2.0, and Sirius' Ray Tracing software had not been previously evaluated using this approach. The Barrett True K formula was the most accurate method for IOL calculation in eyes that had undergone SMILE for myopia correction, outperforming Ray Tracing.
评估并比较五种人工晶状体（IOL）计算方法在先前接受角膜屈光透镜切除术（KLEx）治疗近视的眼中的可预测性。
一项回顾性病例研究纳入了52例接受小切口透镜切除术（SMILE）治疗近视及近视散光的患者的100只眼。获取术前及术后3个月的光学生物测量和角膜地形图测量结果。将手术引起的屈光变化的等效球镜度转换到角膜平面（SMILE-dif）。开发了一种物理上明确的方法，即在SMILE前后植入相同的IOL模型。术前使用光线追踪法（RT-Sirius）以及几种IOL屈光度计算公式（Kane、EVO 2.0、巴雷特通用II公式、霍弗QST）计算IOL屈光度。术后，使用RT-Sirius、Kane（通过光线追踪法计算5.5毫米处的平均瞳孔屈光度）、EVO 2.0近视性LASIK/PRK术后公式、巴雷特真实K公式以及霍弗QST近视性LASIK/PRK术后公式计算IOL屈光度。比较角膜平面中SMILE前后IOL引起的屈光不正差异（IOL-dif）与SMILE-dif。预测误差（PE）计算为SMILE-dif与IOL-dif之间的差值。
使用RT-Sirius、Kane、EVO 2.0、巴雷特真实K和霍弗QST获得的PE分别为0.26±0.55屈光度（D）、0.10±0.45 D、0.40±0.37 D、-0.03±0.36 D、0.02±0.51 D。巴雷特真实K和霍弗QST之间的PE在统计学上无显著差异，巴雷特的差异更均匀（方差σ=0.13）。使用巴雷特真实K获得的绝对预测误差在±0.5 D范围内的病例达到84%，其次是Kane（72%）、霍弗QST（65%）、EVO（61%）和RT-Sirius（59%）。
巴雷特真实K公式是在接受SMILE矫正近视的眼中进行IOL计算的最准确方法。
已知内容 关于SMILE术后IOL屈光度计算的文献稀少，且用于估计LASIK/PRK术后角膜屈光度的方法可能不适用于SMILE手术。研究IOL计算公式可预测性的最常见方法涉及一个包含IOL虚拟植入的理论模型。新内容 霍弗QST公式、使用5.5毫米处平均瞳孔屈光度的Kane公式、EVO 2.0以及Sirius的光线追踪软件此前未使用此方法进行评估。巴雷特真实K公式是在接受SMILE矫正近视的眼中进行IOL计算的最准确方法，优于光线追踪法。
