Purpose: To assess the accuracy of intraocular lens (IOL) power formulas modified specifically for patients with keratoconus (Holladay 2 with keratoconus adjustment and Kane keratoconus formula) compared with normal IOL power formulas (Barrett Universal 2, Haigis, Hoffer Q, Holladay 1, Holladay 2, Kane, and SRK/T). Design: Retrospective consecutive case series. Participants: A total of 147 eyes of 147 patients with keratoconus. Methods: Data from patients with keratoconus who had preoperative IOLMaster biometry were included. A single eye per qualifying patient was randomly selected. The predicted refraction was calculated for each of the formulas and compared with the actual refractive outcome to give the prediction error. Subgroup analysis based on the steepest corneal power measured by biometry (stage 1: 48 diopters [D], stage 2: >48 D and 53 D, and stage 3: >53 D) was performed. Main Outcome Measure: Prediction error. Results: On the basis of the mean absolute prediction error (MAE), the formulas were ranked as follows: Kane keratoconus formula (0.81 D), SRK/T (1.00 D), Barrett Universal 2 (1.03 D), unmodified Kane (1.05 D), Holladay 1 (1.18 D), unmodified Holladay 2 (1.19 D), Haigis (1.22 D), Hoffer Q (1.30 D), and Holladay 2 with keratoconus adjustment (1.32 D). The Kane keratoconus formula had a statistically significant lower MAE compared with all formulas (P < 0.01). In stage 3 keratoconus, all nonmodified formulas had a hyperopic mean prediction error ranging from 1.72 to 3.02 D. Conclusions: The Kane keratoconus formula was the most accurate formula in this series. The SRK/T was the most accurate of the traditional IOL formulas. All normal IOL formulas resulted in hyperopic refractive outcomes that worsened as the corneal power increased. Suggestions for target refractive aims in each stage of keratoconus are given. Ophthalmology 2020;127:1037-1042 ª 2020 by the American Academy of Ophthalmology Keratoconus is a progressive disorder characterized by central or paracentral corneal thinning and ectasia. Intraocular lens (IOL) power calculation in these eyes represents a significant challenge. Kamiya et al 1 reported on 71 patients with keratoconus comparing the Haigis, Hoffer Q, Holladay 1, Holladay 2, and SRK/T formulas and found that that the SRK/T formula was the most accurate with 36% of eyes within 0.50 diopters (D) of the final manifest refraction. Savini et al 2 also found that the SRK/T was the most accurate formula in 41 patients (compared with Barrett Universal 2, Haigis, Hoffer Q, and Holladay 1), with 43.9% of eyes within 0.50 D. Both studies found that all formulas resulted in a hyperopic refractive surprise that worsened with more advanced stages of the disease. Suggestions regarding an appropriate myopic refractive target to avoid unwanted postoperative hyperopic error have been proposed. 3 These refractive results in keratoconus studies are significantly worse than the 75% to 80% of eyes within 0.50 D usually seen in nonkeratoconic eyes, 4 for which there are many reasons. First, the calc...

Penetrating keratoplasty is a safe and effective treatment for selected corneal disorders. Penetrating keratoplasty for viral keratitis may achieve good results with long term antiviral treatment. Patients may achieve better outcomes if their surgery is performed at specialist centres.

Purpose: To determine the optimal age for surgical correction of blepharophimosis. Associated features and their effects on incidence of amblyopia were also investigated. Methods: The study was a retrospective case series of 28 patients with blepharophimosis, ptosis and epicanthus inversus syndrome presenting to a tertiary referral eyelid, lacrimal and orbital clinic. Results: Amblyopia was present in 39% of patients. Patients with coexistent strabismus had a 64% incidence of amblyopia compared to 24% for those without strabismus. Hypermetropia was present in 43% of patients and 7% were myopic. Significant astigmatism was found in 40% of patients, but these factors did not increase the risk of amblyopia. Patients with severe ptosis had lower rates of amblyopia than those with moderate ptosis but had their ptosis corrected at a median age of 2 years compared to 5 years for those with moderate ptosis. There was an 18% incidence of nasolacrimal drainage problems. A good to excellent cosmetic outcome was achieved in 86% of patients. A positive family history was noted in 75% of patients, usually with paternal inheritance. Conclusions: Patients with blepharophimosis have a high rate of amblyopia. Co‐existent strabismus doubles the risk of amblyopia. Ptosis alone causes mild to moderate amblyopia only. Patients with severe ptosis should have their ptosis corrected before 3 years of age, and all other patients should undergo surgery before 5 years of age.

Upper eyelid gold weight implantation causes an increase in corneal astigmatism, predominantly in the vertical axis, which appears to be reversible on removal of the gold weight.