Reitblat Olga, Sella Ruti, Zlatkin Rita, Bahar Irit, Lerman Tsahi T
Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Exp Ophthalmol. 2025 May-Jun;53(4):356-373. doi: 10.1111/ceo.14470. Epub 2024 Dec 3.
Accurate intraocular lens (IOL) calculation in eyes with keratoconus (KCN) poses significant challenges. While various formulas, including KCN-specific ones, have been investigated, the optimal calculation method remains inconclusive.
The study was pre-registered in PROSPERO (CRD42023483119). PubMed, Embase and CENTRAL electronic databases were systematically searched for studies comparing IOL power calculation formulas in eyes with KCN. The percentage of eyes with a prediction error (PE) within ±0.50 D and ±1.00 D, the mean PE and the mean absolute error (MAE) were compared using a random effect model in Bayesian network meta-analysis.
Nine retrospective clinical studies were included, totalling 623 eyes and 25 calculation methods. The Barrett True-K formula for KCN with measured posterior cornea (BTK MPC) achieved the highest ranking for the percentage of PE within ±0.50 D and ±1.00 D, mean PE, and MAE, with surface under the cumulative ranking (SUCRA) of 95%, 95%, 97% and 95%, respectively. Subgroup analysis showed that for the predictability rates within ±0.50 D and ±1.00 D, the best ranking formulas were: Emmetropia Verifying Optical (EVO) (85%) and BTK MPC (78%), respectively, in mild KCN; BTK with predicted posterior cornea (PPC) (85%) and MPC (88%), respectively, in moderate KCN; and Kane KCN for both metrics in severe KCN (84% and 95%, respectively).
The BTK MPC formula ranked highest across various metrics, suggesting its superior accuracy for IOL calculations in KCN. The optimal formulas may differ based on KCN severity, with current evidence suggesting potential advantage of Kane KCN for severe cases.
圆锥角膜（KCN）患者眼内晶状体（IOL）的精确计算面临重大挑战。尽管已经研究了各种公式，包括特定于KCN的公式，但最佳计算方法仍无定论。
该研究已在国际前瞻性注册系统（PROSPERO，注册号：CRD42023483119）中预先注册。系统检索了PubMed、Embase和CENTRAL电子数据库，以查找比较KCN患者眼内晶状体屈光力计算公式的研究。在贝叶斯网络荟萃分析中，使用随机效应模型比较了预测误差（PE）在±0.50 D和±1.00 D范围内的眼的百分比、平均PE和平均绝对误差（MAE）。
纳入了9项回顾性临床研究，共623只眼和25种计算方法。对于PE在±0.50 D和±1.00 D范围内的百分比、平均PE和MAE，测量后角膜的KCN的巴雷特真K公式（BTK MPC）排名最高，累积排名曲线下面积（SUCRA）分别为95%、95%、97%和95%。亚组分析表明，对于±0.50 D和±1.00 D范围内的预测准确率，轻度KCN中最佳排名的公式分别为正视验证光学（EVO）（85%）和BTK MPC（78%）；中度KCN中分别为预测后角膜的BTK（PPC）（85%）和MPC（88%）；重度KCN中两种指标的最佳公式均为凯恩KCN（分别为84%和95%）。
BTK MPC公式在各项指标中排名最高，表明其在KCN患者IOL计算中具有更高的准确性。最佳公式可能因KCN严重程度而异，目前的证据表明重度病例中凯恩KCN可能具有潜在优势。
