Preliminary validation of an optimized algorithm for intraocular lens power calculation in keratoconus

This study aimed to evaluate the theoretical influence on intraocular lens power (PIOL) calculation of the use of keratometric approach for corneal power (Pc) calculation in keratoconus and to develop and validate an algorithm preliminarily to minimize this influence. Methods: Pcwas calculated theoretically with the classical keratometric approach, the Gaussian equation, and the keratometric approach using a variable keratometric index (nkadj) dependent on r1c(Pkadj). Differences in PIOL calculations (ΔPIOL) using keratometric and Gaussian Pcvalues were evaluated. Preliminary clinical validation of a PIOLalgorithm using Pkadj was performed in 13 keratoconus eyes. Results: PIOL underestimation was present if Pc was overestimated, and vice versa. Theoretical PIOLoverestimation up to −5.6 D and −6.2 D using Le Grand and Gullstrand eye models was found for a keratometric index of 1.3375. If nkadjwas used, maximal Δ PIOL was ±1.1 D, with most of the values ≤±0.6 D. Clinically, PIOLunder- and over-estimations ranged from −1.1 to − 0.4 D. No statistically significant differences were found between PIOL obtained with Pkadjand Gaussian equation (P > 0.05). Conclusion: The use of the keratometric Pcfor PIOL calculations in keratoconus can lead to significant errors that may be minimized using a Pkadj approach.The research leading to these results has received funding from the Generalitat Valenciana (Valencian Community, Spain) under the grant for emergent research groups with reference GV2014/086