Journal of refractive surgery最新文献

{"title":"Influence of Lighting, Accommodation, and Pharmacological Conditions on Vault After ICL Implant Refractive Surgery: A Systematic Review.","authors":"Francisco Javier Aguilar-Salazar, Antonio Cano-Ortiz, Timoteo González-Cruces, José-María Sánchez-González","doi":"10.3928/1081597X-20250506-02","DOIUrl":"10.3928/1081597X-20250506-02","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the influence of lighting conditions, accommodation, and the use of drugs on vault measurement in patients implanted with an Implantable Collamer Lens (ICL; STAAR Surgical). This is the first systematic review to date that analyzes published articles assessing vault variation when measured under different lighting, accommodative, and pharmacological conditions.</p><p><strong>Methods: </strong>A systematic review was conducted, including studies reporting vault measurement under different lighting, accommodative, or pharmacological conditions, in two databases: PubMed and Scopus. The search period was from February 2004 to December 14, 2024. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Case Series Studies was used to evaluate the quality of the included studies.</p><p><strong>Results: </strong>This systematic review included 22 studies and a total of 1,690 eyes from 1,094 patients. The influence of lighting conditions, accommodation, and drug use was analyzed in 13, 8, and 6 studies, respectively. Vault decreased from 542.12 ± 103.35 to 442.94 ± 102.76 µm (<i>P</i> < .001) when measured under photopic lighting conditions; this reduction was more evident in patients implanted with V4c models compared to V3 and V4 models.</p><p><strong>Conclusions: </strong>The value of the vault is susceptible to changes depending on the conditions under which it is measured. The vault decreases under photopic lighting conditions, as well as during the accommodative state and after administration of miotic and mydriatic drugs. <b>[<i>J Refract Surg</i>. 2025;41(6):e611-e621.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e611-e621"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Exploring the Impact of Intraocular Higher Order Aberrations on Customized Refractive Surgery in Keratoconus.","authors":"Karim Kozhaya, Carl-Joe Mehanna, Lara Asroui, Romy Bejjani, Samuel Arba-Mosquera, Hazem M Mousa, Saleh Bahir Al-Ulloom, Shady T Awwad","doi":"10.3928/1081597X-20250512-01","DOIUrl":"10.3928/1081597X-20250512-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e622-e623"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative OCT Enables Prediction of 3-Month Postoperative Lens Separation Vault for the Implantable Collamer Lens.","authors":"Maxwell J B Reinstein, Dan Z Reinstein, Timothy J Archer, Ruchi Gupta, Joseph G Potter","doi":"10.3928/1081597X-20250417-06","DOIUrl":"https://doi.org/10.3928/1081597X-20250417-06","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and test a multivariate model using intraoperative optical coherence tomography (iOCT) (ARTEVO 800; Carl Zeiss Meditec) to predict the 3-month lens separation vault of the Implantable Collamer Lens (ICL; STAAR Surgical).</p><p><strong>Methods: </strong>A retrospective analysis of consecutive V4c EVO and EVO+ ICL procedures was conducted at London Vision Clinic, London, United Kingdom. ICL size was preoperatively chosen using Insight 100 VHF digital ultrasound (ArcScan, Inc) and the Reinstein ICL Sizing Formula V2. Central vault was recorded intraoperatively by iOCT. AS-OCT (MS-39; CSO Italia) measured vault at 30 minutes, 1 and 4 days, and 1 and 3 months after surgery. Stepwise multiple linear regression analysis evaluated the correlation between preoperative and iOCT-derived vault measurements with the 3-month vault. A predictive formula was derived and tested on 40 consecutive cases to estimate the accuracy and repeatability of vault prediction.</p><p><strong>Results: </strong>A total of 153 eyes were included in the training set. Mean central vault was 829 ± 330 µm intraoperatively and 594 ± 218 µm at 3 months. Regression analysis indicated that intraoperative vault, ciliary body inner diameter, crystalline lens rise from the sulcus plane, and lens size were significant factors (all <i>P</i> < .001) in predicting the change between intra-operative and 3-month vault. The derived formula predicted the 3-month vault within 100 µm of the achieved vault for 58% of eyes in the test set, within 200 µm for 83%, within 300 µm for 93%, and within 350 µm for 100%.</p><p><strong>Conclusions: </strong>iOCT is a valuable tool for intraoperative determination of lens size suitability, increasing patient safety, and potentially avoiding secondary procedures. <b>[<i>J Refract Surg</i>. 2025;41(6):e575-e584.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e575-e584"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"KERATO Biomechanics Study 2: A Comparative Evaluation Before and After Corneal Cross-Linking Using Brillouin Microscopy and Dynamic Scheimpflug Imaging.","authors":"Riccardo Vinciguerra, Robert Herber, Kaman Zeng Cen, Mario R Romano, Frederik Raiskup, Ramin Khoramnia, Paolo Vinciguerra","doi":"10.3928/1081597X-20250506-01","DOIUrl":"10.3928/1081597X-20250506-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate biomechanical changes induced by epithelium-off corneal cross-linking (CXL) in progressive keratoconus using Brillouin microscopy (BOSS; Intelon Optics) and ultra-high-speed Scheimpflug camera (Corvis ST; Oculus Optikgeräte GmbH).</p><p><strong>Methods: </strong>Twenty-three eyes from 24 patients were included in this retrospective, multicenter study. Biomechanical properties were assessed before and 1 month after CXL using the BOSS and Corvis ST. Brillouin measurements included mean, minimum, and maximum Brillouin frequency shift (BFS) and sectors (inferior, equator, and superior). The Corvis ST assessed dynamic corneal response (DCR) parameters, including inverse concave radius (1/R) and stress-strain index (SSI). Statistical analyses included Wilcoxon tests, Pearson correlation, and linear mixed models, with adjustments for corneal pachymetry.</p><p><strong>Results: </strong>Brillouin microscopy demonstrated significant stiffening after CXL, with increases in mean BFS and maximum BFS, together with inferior and equatorial regions (<i>P</i> < .001). A strong correlation was observed between preoperative BFS and postoperative changes (<i>R</i>² = 0.597, <i>P</i> < .001). The Corvis ST confirmed biomechanical stiffening with a significant decrease in 1/R values (<i>P</i> = .002), although no significant changes were observed in SSI.</p><p><strong>Conclusions: </strong>Both Brillouin microscopy and the Corvis ST effectively detected corneal stiffening after CXL, with Brillouin technology offering localized biomechanical insights. These findings highlight the potential of Brillouin microscopy for guiding customized CXL treatments and underscore its complementary role alongside the Corvis ST. <b>[<i>J Refract Surg</i>. 2025;41(6):e594-e601.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e594-e601"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of Short-term Crystalline Lens Positional Shifts Following ICL Implantation Using SS-OCT Integrated With Multi-task Deep Learning.","authors":"Zhengwei Zhang, Kaiwen Li, Zhao Wang, Jinhan Yao, Shuimiao Chang, Jiewei Liu, Xiaogang Wang","doi":"10.3928/1081597X-20250506-06","DOIUrl":"https://doi.org/10.3928/1081597X-20250506-06","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the tilt and decentration of the crystalline lens shortly after Implantable Collamer Lens (ICL) implantation.</p><p><strong>Methods: </strong>All enrolled patients underwent anterior segment swept-source optical coherence tomography (SS-OCT) both before and within 1 week after ICL surgery. A multitask network automatically conducted SS-OCT image segmentation and provided quantitative assessments of the crystalline lens's tilt and decentration. For data following a normal distribution, paired <i>t</i>-tests were performed, whereas for data not meeting normality assumptions, the Wilcoxon signed-rank test was used.</p><p><strong>Results: </strong>The final data analysis included 42 eyes from 26 patients. No statistically significant difference was observed in the degree of crystalline lens tilt before and after ICL implantation (2.08 ± 0.07 vs 1.94 ± 0.08 degrees, <i>P</i> = .179), with both tilting temporally and demonstrating a significant positive correlation (<i>r</i> = 0.785, <i>P</i> < .001). The degree of postoperative crystalline lens decentration was significantly reduced compared to that before implantation (201 ± 64 vs 192 ± 92 µm, <i>P</i> = .0073), with the decentration predominantly in the upward direction, and demonstrating a strong positive correlation (<i>r</i> = 0.637, <i>P</i> < .001). Additionally, ICL tilt exhibited a strong positive correlation with both preoperative and postoperative lens tilt (<i>r</i> = 0.687, <i>P</i> < .001; <i>r</i> = 0.613, <i>P</i> < .001), as well as with ICL decentration (<i>r</i> = 0.512, <i>P</i> = .001).</p><p><strong>Conclusions: </strong>SS-OCT combined with multi-task deep learning enables quantitative assessment of the spatial position of both the crystalline lens and ICL. Short-term observations indicate that ICL implantation impacts the position of the crystalline lens to varying extents. <b>[<i>J Refract Surg</i>. 2025;41(6):e569-e574.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e569-e574"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical Losartan in the Treatment of Stromal Scarring After Refractive Surgery.","authors":"Steven E Wilson, Barbara A L Dutra, Khushnuma Wahabi","doi":"10.3928/1081597X-20250506-05","DOIUrl":"https://doi.org/10.3928/1081597X-20250506-05","url":null,"abstract":"<p><strong>Purpose: </strong>To review current guidelines for the prophylactic and therapeutic use of topical losartan to prevent and treat corneal scarring fibrosis in refractive surgery.</p><p><strong>Methods: </strong>PubMed was used to search the medical literature.</p><p><strong>Results: </strong>Scarring fibrosis of the cornea is typically associated with injury to, and defective regeneration of, the adjacent overlying epithelial basement membrane that controls transforming growth factor (TGF)-β passage into the stroma, leading to the development and persistence of myofibroblasts. Topical losartan's effects in the cornea are mediated by inhibiting activation of the intracellular signaling molecule extracellular signal-regulated kinase that modulates the responses of TGF-β derived primarily from the tears and epithelium on stromal myofibroblasts in anterior corneal injuries. Topical losartan can be used prophylactically by surgeons who avoid mitomycin C (MMC) in cases with higher correction or other factors associated with the development of \"late haze\" corneal fibrosis. It has also been effective in the treatment of scarring stromal fibrosis once it develops as late haze after photorefractive keratectomy (PRK), breakthrough late haze that occurs despite the use of intraoperative MMC, complicated laser in situ keratomileusis and small incision lenticule extraction cases, the development of visually significant incisional fibrosis after radial keratotomy and astigmatic keratotomy, and in corneas with persistent epithelial defects after any refractive surgical procedure. Cases with bilateral late haze after PRK are less likely to respond to topical losartan due to the underlying defect that originally led to the development of fibrosis affecting the losartan two-phase mechanism of action.</p><p><strong>Conclusions: </strong>Topical losartan has an important role in the refractive surgery armamentarium to prevent or treat scarring fibrosis in the corneal stroma. <b>[<i>J Refract Surg</i>. 2025;41(6):e602-e610.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e602-e610"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everybody Can See.","authors":"Erick Castillo Bastante","doi":"10.3928/1081597X-20250506-03","DOIUrl":"https://doi.org/10.3928/1081597X-20250506-03","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e519"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toric Intraocular Lens Calculations in Eyes With Corneal Ectasia.","authors":"Olga Reitblat, Rita Zlatkin, Nili Golan, Lior Or, Adi Einan-Lifshitz, Uri Elbaz, Irit Bahar, Ruti Sella","doi":"10.3928/1081597X-20250424-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250424-01","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the accuracy of astigmatism correction in patients with corneal ectasia, using various toric intraocular (IOL) calculators.</p><p><strong>Methods: </strong>Consecutive patients with corneal ectasia and a regular astigmatic component, who underwent cataract extraction with implantation of a toric IOL, were retrospectively reviewed. The predicted postoperative refractive astigmatism (RA) was calculated with the Barrett True K (BTK) toric calculator using predicted and measured posterior corneal astigmatism (PPCA and MPCA, respectively), both with and without the Integrated Keratometry (IK) tool. In addition, the Kane toric calculator was used, with its keratoconus function. Based on the manifest postoperative refraction, the error in the predicted astigmatism was calculated for each method.</p><p><strong>Results: </strong>Compared in 36 eyes of 28 patients, IK-PPCA (0.09 diopters [D] @ 76) showed the lowest trimmed mean centroid prediction error for RA, followed by IK-MPCA (0.11 D @ 7), BTKMPCA (0.12 D @ 55), Kane-Keratoconus (0.15 D @ 78) and BTKPPCA (0.28 D @ 82). BTK-PPCA was the only method that significantly deviated from zero (<i>P</i> = .038), and significantly differed from BTK-MPCA (<i>P</i> = .013), IK-PPCA (<i>P</i> = .009), and IK-MPCA (<i>P</i> = .003). IK-MPCA led in precision and accuracy (trimmed mean 0.66 D and 0.67 D, respectively), but not significantly vs IK-PPCA (0.73 D, 0.74 D), BTK-MPCA (0.78 D, 0.79 D), Kane Keratoconus (0.80 D, 0.80 D), and BTK-PPC (0.84 D, 0.88 D).</p><p><strong>Conclusions: </strong>The use of multiple measurements, provided by the IK calculator, enhanced astigmatism correction with toric IOLs in eyes with corneal ectasia. The variability in ectatic corneas likely benefits from a multi-measurement approach. <b>[<i>J Refract Surg</i>. 2025;41(6):e558-e568.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e558-e568"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Visual Function of Enhanced Monofocal Intraocular Versus Monofocal Lenses.","authors":"Koji Komatsu, Yoichiro Masuda, Kei Sano, Ryo Ohira, Shingo Mitooka, Masanobu Iida, Sei Tachibana, Kosuke Ichihara, Tetsutaro Oki, Tadashi Nakano","doi":"10.3928/1081597X-20250417-05","DOIUrl":"10.3928/1081597X-20250417-05","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the postoperative visual performance of the Vivinex Impress (Hoya Surgical Optics) with that of a monofocal intraocular lens (IOL) on the same platform.</p><p><strong>Methods: </strong>This retrospective observational study analyzed consecutive patients who underwent cataract surgery between February and October 2024. Patients with postoperative emmetropia as the target refraction, preoperative corneal astigmatism less than 1.00 diopter (D), no history of refractive surgery, and no other ocular diseases or amblyopia were analyzed. Fifty eyes implanted with the Vivinex Impress (Impress group) were compared with 50 eyes implanted with the Vivinex MultiSert (MultiSert group). One month postoperatively, uncorrected distance visual acuity, uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity, corrected distance visual acuity, and contrast sensitivity were evaluated. Data on patient satisfaction levels, dysphotopsia incidence, and spectacle use rates were obtained.</p><p><strong>Results: </strong>UIVA (logarithm of the minimum angle of resolution) was significantly better in the Impress group (0.12 ± 0.12) compared to the MultiSert group (0.18 ± 0.13) (<i>P</i> = .003), with no significant differences in other visual acuity measures. Multivariate analysis revealed a negative correlation between UIVA and postoperative pupil diameter in the Impress group. Predicted refractive error differed significantly (Impress group: -0.13 ± 0.43 and MultiSert group: 0.10 ± 0.46). No significant differences were observed in the contrast sensitivity, patient satisfaction levels, dysphotopsia incidence, or spectacle use rates between the groups.</p><p><strong>Conclusions: </strong>The Impress group demonstrated superior intermediate visual acuity and a myopic shift from the target refraction. Preoperative pupil diameter may help identify patients most likely to benefit from the Impress lens. <b>[<i>J Refract Surg</i>. 2025;41(6):e551-e557.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 6","pages":"e551-e557"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Modern IOL Power Calculation Formulas in Eyes After Myopic Laser Vision Correction: A Stratified Axial Length Analysis.","authors":"Jianheng Liang, Qian Tan, Zheming Wu, Yun Chen, Ruihong Ju, Haisong Chen, Qiongyan Tang, Yanxue Xu, Li Xu, Julio Ortega-Usobiaga, Danmin Cao, Yong Wang","doi":"10.3928/1081597X-20250328-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250328-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of modern intraocular lens (IOL) power calculation formulas in eyes with previous myopic laser vision correction (LVC), and to assess the impact of axial length (AL) on the formula performance.</p><p><strong>Methods: </strong>A total of 108 eyes were included, with 52 eyes in the AL less than 28 mm group and 56 eyes in the AL 28 mm or greater group. Refractive prediction errors (RPEs) were compared among nine post-LVC formulas: Haigis-TK, Haigis-TK_CMAL (incorporating Cooke-modified axial length [CMAL]), PEARL-DGS, Hoffer-QST TK, LISA TK, Barrett True-K TK, EVO TK, Haigis-L, and Shammas. Pearson correlation analysis was employed to evaluate the influence of AL and other biometric parameters on RPEs.</p><p><strong>Results: </strong>In the AL less than 28 mm group, no significant differences were observed between all formulas (all adjusted <i>P</i> > .05). However, in the AL 28 mm or greater group, Haigis-TK_CMAL demonstrated significantly lower root mean square absolute error (RMSAE) and mean absolute error (MAE) compared to the Hoffer-QST, Barrett True-K TK, Shammas, and Haigis-L (all adjusted <i>P</i> < .001). Similarly, the PEARL-DGS showed significantly lower RMSAE than the Barrett True-K TK, Shammas, and Haigis-L (both adjusted <i>P</i> < .001), and significantly lower MAE compared to the Barrett True-K TK and Haigis-L (both adjusted <i>P</i> < .001). The Haigis-TK_CMAL had the highest percentage of eyes with RPEs within ±0.50 diopters (D) (73.21%), whereas the PEARL-DGS had the highest percentage of eyes with RPEs within ±1.00 D (94.64%). A significant negative correlation between AL and RPE was found in most formulas, leading to a myopic shift in eyes with extremely long AL.</p><p><strong>Conclusions: </strong>The performance of current post-LVC formulas was comparable in eyes with AL less than 28 mm, whereas the Haigis-TK_CMAL and PEARL-DGS demonstrated superior accuracy in eyes with AL 28 mm or greater. A notable myopic shift occurred in post-LVC eyes with extremely long AL, highlighting the need for careful formula selection in such cases. <b>[<i>J Refract Surg</i>. 2025;41(5):e435-e443.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 5","pages":"e435-e443"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}