Retrospective Analysis of IOL Power Calculation by Ray Tracing in Eyes with Previous Radial Keratotomy

<b>Background/Objectives</b>: To evaluate the predictive accuracy of intraocular lens (IOL) power calculation by ray tracing in eyes with previous radial keratotomy (RK). <b>Methods</b>: A consecutive series of eyes with previous RK was retrospectively analyzed. Preoperatively, all eyes underwent optical biometry to measure the axial length (AL) and anterior segment imaging by the MS-39 (CSO), which combines Placido disk corneal topography and anterior segment optical coherence tomography. The built-in ray tracing software was used to calculate the IOL power. For comparative purposes, the results of the Barrett True-K, EVO, Haigis total keratometry, and PEARL-DGS formulas were also investigated. The refractive outcomes were evaluated with Eyetemis. <b>Results</b>: Twenty-four eyes (24 patients) were investigated. The mean AL and keratometry were, respectively, 27.34 ± 2.88 mm and 35.53 ± 3.66 diopters (D). The mean prediction error (PE) was -0.03 ± 0.65 D (range: from -1.30 to +1.64 D). The mean and median absolute errors were 0.52 and 0.48 D, respectively. The percentages of eyes with a PE within ±0.25 D, ±0.50 D, and ±1.00 D were 29.17%, 62.50%, and 87.50%, respectively. A comparison with the other formulas was possible in 20 eyes and did not reveal any statistically significant differences; the percentage of eyes with a PE within ±0.50 D ranged from 50 to 65%. <b>Conclusions</b>: Ray tracing is a relatively accurate solution for calculating the IOL power in eyes with previous RK. Paraxial formulas provide similar outcomes and should be considered in these patients. The refractive outcomes of IOL power calculation in post-RK eyes are still below modern benchmarks for virgin eyes.