Résumé
This study assessed the reliability of biometric formulas currently used at the Gui de Chauliac University Hospital of Montpellier, France, for intra-ocular lens (IOL) power calculation in patients undergoing combined Descemet stripping automated endothelial keratoplasty (DSAEK) and phacoemulsification (PKE). Design: single-center, retrospective, observational cohort study conducted at Gui de Chauliac University Hospital, Montpellier. Participants: the study involved adults with Fuch’s endothelial dystrophy who underwent combined DSAEK and PKE from 2017 to 2023, with a minimum postoperative follow-up of 6 months. Methods: medical records of patients were thoroughly reviewed, including detailed preoperative ophthalmic examinations. Data collection focused on baseline demographic and clinical information, intraoperative details about the graft preparation, IOL characteristics, and biometric formulas used for IOL power calculation. The primary outcome was the refractive prediction error for each biometric formula (Barrett, SRK/T, Hoffer Q, Holladay 1 and 2, Haigis), allowing a comparative analysis of their accuracy in this combined surgical context. Results: a total of 65 eyes from 53 patients were included; the mean age of patients was 69.7±6.4 years. Six months post-surgery, the mean best-corrected visual acuity was 0.21±0.14 LogMAR, with mean spherical equivalent 0.93±0.95 D. Visual acuity, graft thickness, and refractive outcomes significantly improved, but corneal thickness remained unchanged. The refractive prediction errors, in ascending order, were 1.34 ± 0.91 D for Holladay 2, 1.42 ± 0.93 D for both Hoffer Q and Haigis, 1.43 ± 0.89 D for SRK/T, 1.44 ± 0.90 D for Holladay 1, and 1.54 ± 0.90 D for Barrett. Holladay 2 had the smallest mean refractive error (p < 0.004) and Barrett the largest (p < 0.001). We found no significant correlations among axial length, keratometry, graft thickness, pachymetry, central-to-peripheral graft thickness ratio, and postoperative refractive shifts. Conclusion: although none of the tested formulas could precisely target emmetropia, Holladay 2 yielded promising results in patients undergoing combined DSAEK and PKE. A preoperative target refraction of at least -1 D is suggested. Further research with larger sample sizes is needed to validate these findings.