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Refining Intraocular Lens Calculation in Phacoemulsification and DMEK: Comparison of Three Methods.

David Mingo-Botín1,2, Pablo de-Arriba-Palomero1, Oscar Gris2

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|December 10, 2025
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Summary
This summary is machine-generated.

Three keratometric adjustment methods improved refractive predictions after Descemet membrane endothelial keratoplasty (DMEK). These adjustments reduced hyperopic error compared to standard formulas, with Haigis-D showing the lowest error and HaigisCombi achieving the highest accuracy within ±1.00 D.

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Refractive Error Analysis

Background:

  • Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure for endothelial dysfunction.
  • Accurate refractive outcomes after DMEK are crucial for patient satisfaction.
  • Tomographic changes post-DMEK can influence refractive predictability.

Purpose of the Study:

  • To identify tomographic alterations causing refractive shifts after DMEK.
  • To compare three novel keratometric adjustment methods against conventional formulas for refractive prediction accuracy.

Main Methods:

  • Retrospective analysis of biometric, topographic, and refractive data from 112 eyes undergoing phacoemulsification and DMEK.
  • Evaluation of four keratometric adjustment strategies: conventional, back-to-front (BF) ratio adjustment, HaigisCombi, and Haigis-D (linear regression).
  • Calculation of prediction error metrics including Mean Absolute Error (MAE) and Median Absolute Error (MedAE).

Main Results:

  • Significant tomographic parameter changes were observed post-DMEK.
  • Posterior keratometry, asphericity, BF ratio, and pachymetry correlated with hyperopic outcomes.
  • All three adjustment methods reduced hyperopic prediction error; Haigis-D yielded the lowest MAE/MedAE, and HaigisCombi had the highest percentage of eyes within ±1.00 D.

Conclusions:

  • Keratometric adjustments effectively reduce prediction errors and hyperopic outcomes post-DMEK compared to unadjusted formulas.
  • The BF ratio and linear keratometry adjustments show promise for improving refractive predictability.
  • Further validation through prospective studies is recommended for these novel adjustment methods.