Research progress on intraocular lens power calculation in cataract patients with prior radial keratotomy

Radial keratotomy (RK) was a refractive procedure widely used to correct myopia from the 1980s to the 1990s. Although this technique has been gradually replaced by modern laser corneal refractive surgery, a large number of post-RK patients are now entering their senior years and requiring cataract surgery. The altered corneal morphology after RK poses unique challenges for intraocular lens (IOL) power calculation, including changes in the relationship between anterior and posterior corneal curvatures, difficulty in predicting effective lens position, irregular corneal astigmatism, and diurnal fluctuation of refraction. In recent years, with the development of new-generation IOL calculation formulas, artificial intelligence algorithms, and adjustable IOL technologies, the refractive outcomes of cataract surgery in post-RK patients have significantly improved. This narrative review summarizes the changes in corneal biomechanical and optical properties after RK, evaluates the reported accuracy of existing IOL formulas for post-RK eyes, discusses intraoperative considerations and postoperative complication management, and prospects the application of novel adjustable IOLs and small-aperture IOLs in this patient population.