Refractive lensectomy strategies in patients with previous hyperopic corneal photoablation: A systematic review.

Abstract Topic: This systematic review assessed and summarized the current available evidence on refractive lensectomy strategies in patients with prior hyperopic corneal photoablation. The review focused on the performance of intraocular lens (IOL) power calculation methods, refractive predictability, visual outcomes and cornea-IOL aberrational matching. Clinical relevance: Eyes with previous hyperopic corneal photoablation exhibit abnormal corneal geometry, high negative spherical aberration, and unpredictable effective lens position, making IOL power calculation highly challenging. Methods: Eligibility criteria included original clinical studies reporting cataract or lensectomy surgery outcomes in patients with previous hyperopic corneal photoablation. Searches were performed in Pubmed, Embase, Scopus and Web of Science, until October 26 th , 2025. Two reviewers independently screened studies and extracted data. A qualitative synthesis was conducted due to heterogeneity. (PROSPERO): CRD42024548158. Results: Eighteen records were included, predominantly retrospective. Eleven studies assessed IOL formulas, showing that Barrett True-K No History, Haigis-L and Haigis-TK had the most consistent MAE/MedAE performance, with several studies reporting >70% of eyes within the range of ±0.50D. Only a minority of studies evaluated spherical aberration or visual quality, data on enhancements, and its relation with the implanted IOL. Conclusion: The current evidence regarding refractive lensectomy strategies in patients with previous hyperopic refractive corneal photoablation surgery is heterogeneous, scarce and methodologically limited. Most of the published studies addressed IOL calculation formulas, showing that Barrett True K-NH and Haigis-L/Haigis-TK showed the best accuracy based on MAE, MedAE, and proportion of eyes within ± 0.50 D and ± 1.0 D.