Biometric and keratometry parameters after intracorneal ring segments implantation: A comparison between Pentacam AXL and IOL Master 700

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The focus is on assessing the interchangeability of these devices for intraocular lens power calculations, crucial for effective cataract surgery in individuals with corneal ectasia. Method: Twenty-one eligible patients, post intracorneal ring segments implantation at Khalili Hospital, underwent pre-surgery examinations and biometrics measurements using Pentacam AXL and IOL Master 700. The devices were employed randomly and expert operators, blinded to each other's results, conducted the measurements. Data were analyzed using SPSS version 23 with statistical analysis performed using parametric and non-parametric tests based on the distribution of quantitative variables. Result: Significant differences were observed in anterior chamber depth (ACD), mean keratometry (KM), K2, and white-to-white (WTW) measurements between Pentacam AXL and IOL Master 700, particularly in the left eye. While ACD and K2 showed significant differences in both male and female groups; similar results have been reported for KM and K1 only in the female group. Conclusion: Despite the differences, the study concludes that the clinical impact on intraocular lens power calculation is negligible. Eye biometric data from both devices can be interchangeably used for determining intraocular lens numbers in patients with intracorneal ring segments implantation undergoing cataract surgery. The study emphasizes caution in considering parameter-specific variations and calls for broader studies to enhance generalizability. Biometry Intracorneal ring segments implantation (ICRS) IOL Master 700 Pentacam AXL Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Corneal rings implantation is used for corneal ectasis correction through intra-corneal rings. Although the intracorneal ring segments implantation is initially designed and used for low myopia treatment, keratoconus treatment became this operation's main goal. [ 1 – 3 ] Implantation of these rings in the corneal periphery acts as arc length shortening. As the anterior corneal surface becomes flattened, it will result in myopia correction. [ 4 ] After a while using these rings was suggested for keratoconus correction and seemed to be an alternative option for corneal transplantation or postponing this procedure. [ 5 – 7 ] With the increasing utilization of corneal rings implantation, especially among an aging population, a significant proportion of these patients may eventually require cataract surgery. However, determining the appropriate intraocular lens (IOL) power in these cases poses a challenge due to alterations in corneal curvature caused by the presence of the corneal ring. Patients facing this scenario typically have three options: 1. undergoing cataract surgery while retaining the corneal ring, 2. removing the corneal ring prior to cataract surgery and waiting for corneal stability before proceeding with IOL calculation, or 3. simultaneously removing the corneal ring and performing cataract surgery. A subset of patients may choose to retain their corneal ring during cataract surgery, necessitating careful consideration of the associated challenges, particularly regarding accurate IOL calculation. This unique subset requires a nuanced approach to ensure optimal surgical outcomes and effective visual rehabilitation.[ 8 ] IOL Master 700 is a device used for imagining and evaluating ocular biometrics. The core principle of this device is swept-source optical coherence tomography. On the other hand, the Scheimpfluge imaging principle combined with partial coherence interferometry forms the backbone of Pentacam AXL. [ 9 ] Although keratometry data from the IOL Master device is the most applied value for intraocular lens calculation and has been long considered the gold standard, more recently, Pentacam anterior segment imaging for evaluating preoperative ocular status has played a more crucial role. [ 10 – 12 ] Nowadays, using Pentacam has become more widespread as a device that produces repeatable measurements and has found its place in assessing the biometric status of eyes which developed cataracts and have had refractive surgery. [ 13 – 15 ] Based on the anterior corneal curvature, IOL Master can measure K values. [ 10 , 11 ] As the Pentacam device can image the anterior and posterior corneal surfaces, it can measure corneal topography, pachymetry and keratometry, and the true net power of the cornea. [ 16 ]The latter cannot be evaluated directly by the IOL master device because it cannot assess the posterior surface of the cornea. [ 17 , 18 ] To the best of our knowledge, different techniques such as partial coherent interferometry and immersion ultrasound are used to calculate intraocular lens power and result in fewer errors in measuring anterior and posterior length values. However, improvement cannot be achieved unless we pay attention to errors in measuring corneal power. To date, no study has compared keratometry with Pentacam AXL versus the IOL Master 700 device in patients with implanted intracorneal ring segments. This study aimed to compare ocular biometrics in Pentacam AXL device versus IOL Master 700 in patients with implanted intracorneal ring segments. Method The study focused on patients who underwent corneal ectasia treatment via intra-stromal implantation of segment rings of Keraring type at Khalili Educational and Medical Center, Shiraz, Iran. This study was approved by the Research Ethics Committees of the School of Medicine, Shiraz University of Medical Sciences, Iran with approval ID: IR.SUMS.MED.REC.1400.345. At least six months elapsed between their intracorneal ring surgery and the current keratometry assessment. Out of the total population, 21 eligible patients were included based on the following criteria: Inclusion criteria comprised of patients aged 18 to 60 years who had undergone ICRS implantation surgery. Exclusion criteria encompassed a history of glaucoma, eye trauma, non-corneal ectasia-related retinal pathology, intraocular surgery, and intraocular pathologies such as coloboma and cataract. Additionally, patients with any postoperative problem or complications such as improperly positioned or inadequately placed at the correct depth rings, and any corneal opacity potentially affecting the calculation of IOL power. Data collection included pre-surgery examinations, i.e. visual acuity test, slit lamp eye examinations, intraocular pressure measurements, and retinal/optic nerve assessments. Biometric measurements were conducted using Pentacam AXL and IOL Master devices. Skilled operators, blinded to each other's results, performed measurements, and devices were employed randomly. Data were analyzed using SPSS version 23. Statistical analysis Based on the Kolmogorov-Smirnov test of normality, the distribution of data was assessed. If the distribution was normal, a parametric Paired Sample T-test was applied for dependent samples; otherwise, a non-parametric Wilcoxon test was used. The Bland-Altman plot was employed to visually represent the level of agreement between the two methods. Result A total number of 21 patients with intracorneal ring implantation who underwent ICRS implantation surgery from 1392 to 1400 at Khalili Educational and Medical Center in Shiraz, Iran were selected randomly based on inclusion criteria. Among these patients, 10 were female (47.6%) and 11 were male (52.4%); more than half of them had ICRS implantation surgery on their left eye (n = 12, 57.1%) while the remaining had the surgery on their right eye (n = 9,42.9%). The mean age of the subjects was 35.47(± 6.43) years; The eldest one was 47 years old while the youngest one was 22 (Table 1 ). Table 1 Clinical characteristics of 21 subjects Parameters Values Mean age; year ± SD 35.47 ± 6.43 Sex; n (%) male 11(52.4) female 10(47.6) SD: standard deviation The Kolmogorov-Smirnov test was employed to assess the normal distribution of quantitative data. Based on the result of the normality test, the Paired Sample T-test was utilized to compare the means between the values obtained from two devices if the results had normal distribution; whereas the Wilcoxon test was used for data that did not have a normal distribution. Table 2 presents means of AL, ACD, KM, K1, K1 Meridian, K2, K2 Meridian, White-White distance, IOL power (Haigis), and IOL power (SRK/T) in IOL Master700 versus Pentacam AXL totally and it is also based on eye and gender separately. P-values less than 0.05 are considered statistically significant. Among these variables, ACD, KM, K2, and WTW showed significant differences between the two devices we studied (p value < 0.05) (Fig. 1 – 4 ). All these four mentioned variables also had significant differences in the left eye (OS). However, no statistically significant difference was reported among all the variables reviewed in this study in the right eye (OD) (p value > 0.05). According to the classification, KM and K1 with p-values of (0.002, 0.005) which indicates significance differed only in the female group while both male and female groups significantly differed regarding ACD and K2 (p value < 0.05). Results did not bring significant changes in other parts of this study. Table 2 Comparison of AL, ACD, KM, K1, K1 Meridian, K2, K2 meridian, White-White distance IOL power (Haigis), and IOL power (SRK/T) between IOL Master 700 and Pentacam AXL totally and among eye and sex group of 21 patients Parameters IOL Master700 Mean ± SD Pentacam AXL Mean ± SD Difference between the two devices P-value AL Total 24.34 ± 1.54 24.37 ± 1.55 -0.03 0.164 OS 24.03 ± 1.38 24.06 ± 1.39 -0.03 0.293 OD 24.75 ± 1.73 24.78 ± 1.74 -0.02 0.406 Male 24.76 ± 1.54 24.78 ± 1.55 -0.02 0.477 Female 23.88 ± 1.48 23.92 ± 1.50 -0.04 0.878 ACD Total 3.59 ± 0.33 3.66 ± 0.33 -0.07 0.004 OS 3.54 ± 0.39 3.60 ± 0.38 -0.06 0.026 OD 3.66 ± 0.23 3.72 ± 0.25 -0.07 0.084 Male 3.59 ± 0.25 3.64 ± 0.23 -0.05 0.029 Female 3.59 ± 0.41 3.67 ± 0.43 -0.09 0.025 KM Total 46.01 ± 2.95 45.59 ± 2.54 0.42 0.009 OS 45.9 ± 3.29 45.38 ± 2.88 0.52 0.017 OD 46.17 ± 2.61 45.87 ± 2.14 0.30 0.261 Male 44.88 ± 2.95 44.65 ± 2.61 0.22 0.363 Female 47.26 ± 2.52 46.62 ± 2.13 0.64 0.002 K1 Total 44.30 ± 3.47 44.02 ± 2.95 0.28 0.136 OS 44.27 ± 3.56 43.98 ± 3.22 0.28 0.198 OD 44.34 ± 3.56 44.07 ± 2.73 0.27 0.435 Male 42.85 ± 3.71 42.78 ± 3.02 0.06 0.839 Female 45.89 ± 2.48 45.38 ± 2.29 0.51 0.005 K1 Mer Total 36.71 ± 28.99 36.00 ± 26.38 0.71 0.820 OS 35.25 ± 29.60 35.33 ± 28.56 -0.08 0.977 OD 38.67 ± 29.82 36.89 ± 24.83 1.77 0.789 Male 40.73 ± 36.93 39.73 ± 31.89 1.00 0.229 Female 32.30 ± 17.64 31.90 ± 19.51 0.40 0.904 K2 Total 47.87 ± 2.56 47.14 ± 2.32 0.73 0.001 OS 47.60 ± 3.07 46.77 ± 2.70 0.83 0.004 OD 48.23 ± 1.78 47.63 ± 1.73 0.59 0.066 Male 47.17 ± 2.35 46.48 ± 2.38 0.69 0.030 Female 48.64 ± 2.69 47.86 ± 2.14 0.78 0.005 K2 Mer Total 126.71 ± 28.99 126.00 ± 26.38 0.71 0.820 OS 125.25 ± 29.60 125.33 ± 28.56 -0.08 0.977 OD 128.67 ± 29.82 126.89 ± 24.83 1.77 0.789 Male 130.73 ± 36.93 129.73 ± 31.89 1.00 0.229 Female 122.30 ± 17.64 121.90 ± 19.51 0.40 0.904 WTW Total 12.20 ± 0.60 12.02 ± 0.47 0.18 0.045 OS 12.21 ± 0.53 12.03 ± 0.54 0.18 0.012 OD 12.20 ± 0.72 12.02 ± 0.39 0.18 0.369 Male 12.38 ± 0.62 12.16 ± 0.39 0.22 0.066 Female 12.01 ± 0.54 11.87 ± 0.53 0.14 0.163 IOL(Haigis) Total 15.17 ± 5.78 15.26 ± 5.32 -0.09 0.768 OS 16.34 ± 3.67 16.47 ± 3.54 -0.13 0.682 OD 13.61 ± 7.77 13.64 ± 6.95 -0.03 0.767 Male 15.32 ± 7.55 15.26 ± 6.82 0.05 1.000 Female 15.00 ± 3.32 15.25 ± 3.33 -0.24 0.465 IOL(SRK/T) Total 15.35 ± 6.10 15.58 ± 5.73 -0.22 0.130 OS 16.76 ± 3.29 16.92 ± 3.43 -0.16 0.326 OD 13.48 ± 8.45 13.79 ± 7.72 -0.31 0.236 Male 14.95 ± 8.04 15.18 ± 7.38 -0.23 0.563 Female 15.80 ± 3.25 16.01 ± 3.48 -0.21 0.114 AL: axial length, ACD: anterior chamber depth, KM: mean keratometry, K1: flat keratometry, K2: steep keratometry, WTW: White-White distance, IOL(Haigis): IOL power which was calculated with Haigis formula, IOL(SRK/T): IOL power which was calculated with SRK/T formula, OD: oculus dexter, OS: oculus sinister Discussion In a comprehensive review, various advanced optical biometric tools, including IOLMaster 700, IOLMaster 500, Pentacam AXL, and Sirius are being used at present time. This study focuses on comparing Pentacam AXL and IOLMaster 700 in terms of biometric and keratometry measurements and also IOL power calculation using Haigis or SRK/T formula. The anticipated outcomes of this research could provide valuable insights for clinicians in selecting the most optimal approach for IOL calculation prior to cataract surgery in patients with stable, well-positioned, and successfully implanted intracorneal rings. AL and corneal keratometry play a crucial role in determining lens prescription. Studies highlight the significance of even a small 0.1 mm change in AL, causing up to 0.27 diopters change in lens measurements. Despite consistent discussions on the alignment between Pentacam AXL and IOL Master 700 in AL measurements, variations exist. Rivero's study showed a difference of 0.0244 ± 0.0130, favoring higher values with Pentacam AXL [ 19 ]. Kiraly et al. reported a minimal impact on lens sizing, supporting interchangeability[ 20 ]. Our study on the AL index revealed a small discrepancy of 0.03, with no significant difference between the two devices. Shajari et al.'s findings also aligned with our results, indicating negligible differences in AL measurements[ 21 ]. The depth of the anterior chamber influences lens power specifically; a 1 mm change can result in a 1.44 diopter alteration[ 22 ]. Inconsistencies in ACD measurements between Pentacam AXL and IOL Master 700 are noted, with Pentacam often providing higher values. Our study found a significant ACD difference of 0.07, consistently favoring Pentacam AXL. Literature suggests potential interchangeability between the devices, acknowledging slight differences in ACD measurements [ 23 – 26 ]. Despite discrepancies, Savant et al. and Woodmass and Rocha found no statistically significant differences in any index between the devices[ 27 , 28 ]. Accurate WTW measurement is essential for determining the size of implantable Collamer lenses. Discrepancies between Pentacam AXL and IOL Master devices have been observed, with IOL Master often reporting larger values. Salouti et al. cautioned against substituting one device for the other [ 29 ]. Our study found a significant difference in the WTW index, with IOL Master 700 calculating a higher WTW distance on average. Sayed et al.'s findings supported shorter WTW line measurements with Pentacam compared to IOL Master, emphasizing the importance of careful interpretation[ 30 , 31 ]. In summary, while certain measurements demonstrate potential interchangeability between Pentacam AXL and IOLMaster 700, caution is advised considering differences across specific parameters. The device selection may depend on the clinical context and the specific measurements required for accurate lens sizing and prescription. In a comprehensive review, studies assessing interchangeability between Pentacam AXL and IOLMaster 700 reveal variable outcomes across parameters. Mustafa Aksoy et al support interchangeability for IOLMaster 700 K and Pentacam EKR 4.5 mm measurements[ 32 ]. Our study aligns, finding no significant differences in SRK/T and Haigis formula, but a significant Km index disparity. Soltani Moghadam et al. (2017) emphasize correlations in Pentacam indices related to keratoconus, highlighting max K, mean K and corneal astigmatism having the most correlation between anterior and posterior elevation differences [ 33 ]. Li et al. (2020) report good compatibility for AL, ACD, and CCT but limited one for WTW and Km interchangeability [ 34 ]. Reuland et al. (2019) suggest Pentacam as a biometric device with comparable keratometry measurements to IOLMaster[ 35 ]. Wang et al. (2019) demonstrate agreement among Pentacam AXL, IOLMaster 700, and IOLMaster 500 in cataract patients [ 36 ]. Haddad et al. (2020) note similar AL and K constant measurements but statistical ACD, slope K, and mean K differences between IOLMaster 500 and Pentacam AXL[ 37 ]. Caution is advised, considering parameter-specific variations in device selection for clinical contexts[ 33 – 37 ]. The study acknowledges limitations such as the absence of entirely similar studies and a small statistical population. To improve confidence in the results and enhance generalizability, the researchers emphasize the need for more extensive studies with a broader participant base. The study's limitations include a restricted number of patients who underwent intracorneal ring implantation, and this is attributed to the scarcity of patient records and the excessive costs associated with such procedures. To overcome these limitations, future research should aim for larger and more diverse samples to ensure more robust and widely applicable conclusions. The next limitation of the study is that we solely compared the results of intraocular lens (IOL) calculation among different formulas without accompanying data on postoperative outcomes. Consequently, we cannot definitively ascertain the superiority of one method over another. Our conclusions are confined to the level of agreement observed between the various methods of IOL calculation. Therefore, this study primarily serves as an initial assessment of agreement among different methods, and further investigations incorporating post-surgical outcomes are essential to establish the optimal method. Furthermore, a limitation stems from the absence of comprehensive details regarding the post-operative functional outcomes of patients, such as visual acuity and satisfaction. This lack of information may constrain our ability to thoroughly analyze the impact of these factors on the study outcomes. Conclusion This research compares eye biometric data obtained from Pentacam AXL and IOL Master 700 in patients who underwent intracorneal ring implantation. These patients, who may have residual refractive errors or cataracts, are at risk of miscalculations affecting intraocular lens power calculations. The study reveals a significant difference between the two devices in the anterior chamber depth (ACD) index in the left eye and in both genders, keratometry (KM) index in the female gender and in the left eye, K1 index in the female gender, K2 index in the left eye and in both genders and white-to-white (WTW) index in the left eye. Despite these statistically significant differences, the study emphasizes that the clinical impact on intraocular lens power calculation is negligible. Consequently, eye biometric data from both devices can be interchangeably used in determining intraocular lens numbers for cataract surgery in these patients. In other investigated cases, no significant differences were observed between the two devices. Declarations Conflict of Interest: Shahram Bamdad, and Mohammadreza Khalili; Amirmohammad Fathian, and Alireza Attar declare that they have no conflict of interest. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of The Human Ethics Committee of Shiraz University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. the participants in the study were fully informed about the goals, cooperation, benefits, and potential harms of the study and completed the ethical consent forms. Consent for publication: All authors have read and approved the final version of the manuscript and agree to its submission to Journal of Ophthalmic Inflammation and Infection. The authors also consent to the publication of the manuscript in the journal and affirm that the work is original, has not been published previously, and is not under consideration for publication elsewhere. Competing interests: Shahram Bamdad, and Mohammadreza Khalili; Amirmohammad Fathian, and Alireza Attar declare that they have no competing interest. Funding: The authors received no funding for the study from any organization. Author Contribution Data was gathered by alireza attar; drafting by Alireza Attar, Shahram Bamdad, and Mohammadreza Khalili; analysis by Amirmohammad Fathian; and revision completed by Alireza Attar. Acknowledgments: n/a Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Asbell PA et al. Adjustability of refractive effect for corneal ring segments. (1081-597X (Print)). Schanzlin DJ et al. The intrastromal corneal ring segments. 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Cite Share Download PDF Status: Published Journal Publication published 18 Feb, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 22 Nov, 2024 Editor assigned by journal 19 Nov, 2024 Submission checks completed at journal 19 Nov, 2024 First submitted to journal 13 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5448784","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381428148,"identity":"77ebf77c-994a-45aa-8ae0-0afd1f7247da","order_by":0,"name":"shahram bamdad","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"shahram","middleName":"","lastName":"bamdad","suffix":""},{"id":381428149,"identity":"7ab016b7-022b-4a5b-ad0f-5f3d3302df29","order_by":1,"name":"amirmohammad 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attar","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"alireza","middleName":"","lastName":"attar","suffix":""}],"badges":[],"createdAt":"2024-11-13 17:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5448784/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5448784/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-03914-2","type":"published","date":"2025-02-18T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71881020,"identity":"79a58c9a-de46-4e65-b5f7-53a464640b56","added_by":"auto","created_at":"2024-12-19 11:36:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59469,"visible":true,"origin":"","legend":"\u003cp\u003eThe Bland-Altman plot comparing the anterior chamber depth difference in Pentacam AXL versus IOL Master 700 in patients with intracorneal ring segments implantation (SD=mean±1.96)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5448784/v1/7577b115fdfb94110f63e0ee.png"},{"id":71881018,"identity":"2ab890fa-17b7-44b1-81a8-e18ade458cf3","added_by":"auto","created_at":"2024-12-19 11:36:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52704,"visible":true,"origin":"","legend":"\u003cp\u003eThe Bland-Altman plot comparing the KM difference in Pentacam AXL versus IOL Master 700 in patients with intracorneal ring segments implantation (SD=mean±1.96)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5448784/v1/056c2f7a5591b362ca8a261c.png"},{"id":71881021,"identity":"262f7a6d-a7e3-45a9-9c3c-514bf65968aa","added_by":"auto","created_at":"2024-12-19 11:36:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":55972,"visible":true,"origin":"","legend":"\u003cp\u003eThe Bland-Altman plot comparing the K2 difference in Pentacam AXL versus IOL Master 700 in patients with intracorneal ring segments implantation (SD=mean±1.96)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5448784/v1/db16de509ebee599b3c9e3eb.png"},{"id":71882394,"identity":"419231b4-5fcf-4b96-a8f0-8d528e2c6d94","added_by":"auto","created_at":"2024-12-19 11:44:27","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":50330,"visible":true,"origin":"","legend":"\u003cp\u003eThe Bland-Altman plot comparing the WTW difference in Pentacam AXL versus IOL Master 700 in patients with intracorneal ring segments implantation (SD=mean±1.96)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5448784/v1/60a1936a3e8e83c5904871f6.png"},{"id":77052703,"identity":"15d9d3ea-87a2-4adb-8311-73126952e6f4","added_by":"auto","created_at":"2025-02-24 16:23:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":955406,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5448784/v1/c9d90f54-f4f9-49d5-b106-1b74d26915ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biometric and keratometry parameters after intracorneal ring segments implantation: A comparison between Pentacam AXL and IOL Master 700","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCorneal rings implantation is used for corneal ectasis correction through intra-corneal rings. Although the intracorneal ring segments implantation is initially designed and used for low myopia treatment, keratoconus treatment became this operation's main goal. [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Implantation of these rings in the corneal periphery acts as arc length shortening. As the anterior corneal surface becomes flattened, it will result in myopia correction. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] After a while using these rings was suggested for keratoconus correction and seemed to be an alternative option for corneal transplantation or postponing this procedure. [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] With the increasing utilization of corneal rings implantation, especially among an aging population, a significant proportion of these patients may eventually require cataract surgery. However, determining the appropriate intraocular lens (IOL) power in these cases poses a challenge due to alterations in corneal curvature caused by the presence of the corneal ring. Patients facing this scenario typically have three options: 1. undergoing cataract surgery while retaining the corneal ring, 2. removing the corneal ring prior to cataract surgery and waiting for corneal stability before proceeding with IOL calculation, or 3. simultaneously removing the corneal ring and performing cataract surgery. A subset of patients may choose to retain their corneal ring during cataract surgery, necessitating careful consideration of the associated challenges, particularly regarding accurate IOL calculation. This unique subset requires a nuanced approach to ensure optimal surgical outcomes and effective visual rehabilitation.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] IOL Master 700 is a device used for imagining and evaluating ocular biometrics. The core principle of this device is swept-source optical coherence tomography. On the other hand, the Scheimpfluge imaging principle combined with partial coherence interferometry forms the backbone of Pentacam AXL. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough keratometry data from the IOL Master device is the most applied value for intraocular lens calculation and has been long considered the gold standard, more recently, Pentacam anterior segment imaging for evaluating preoperative ocular status has played a more crucial role. [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Nowadays, using Pentacam has become more widespread as a device that produces repeatable measurements and has found its place in assessing the biometric status of eyes which developed cataracts and have had refractive surgery. [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Based on the anterior corneal curvature, IOL Master can measure K values. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] As the Pentacam device can image the anterior and posterior corneal surfaces, it can measure corneal topography, pachymetry and keratometry, and the true net power of the cornea. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]The latter cannot be evaluated directly by the IOL master device because it cannot assess the posterior surface of the cornea. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] To the best of our knowledge, different techniques such as partial coherent interferometry and immersion ultrasound are used to calculate intraocular lens power and result in fewer errors in measuring anterior and posterior length values. However, improvement cannot be achieved unless we pay attention to errors in measuring corneal power. To date, no study has compared keratometry with Pentacam AXL versus the IOL Master 700 device in patients with implanted intracorneal ring segments. This study aimed to compare ocular biometrics in Pentacam AXL device versus IOL Master 700 in patients with implanted intracorneal ring segments.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe study focused on patients who underwent corneal ectasia treatment via intra-stromal implantation of segment rings of Keraring type at Khalili Educational and Medical Center, Shiraz, Iran. This study was approved by the Research Ethics Committees of the School of Medicine, Shiraz University of Medical Sciences, Iran with approval ID: IR.SUMS.MED.REC.1400.345. At least six months elapsed between their intracorneal ring surgery and the current keratometry assessment. Out of the total population, 21 eligible patients were included based on the following criteria: Inclusion criteria comprised of patients aged 18 to 60 years who had undergone ICRS implantation surgery. Exclusion criteria encompassed a history of glaucoma, eye trauma, non-corneal ectasia-related retinal pathology, intraocular surgery, and intraocular pathologies such as coloboma and cataract. Additionally, patients with any postoperative problem or complications such as improperly positioned or inadequately placed at the correct depth rings, and any corneal opacity potentially affecting the calculation of IOL power. Data collection included pre-surgery examinations, i.e. visual acuity test, slit lamp eye examinations, intraocular pressure measurements, and retinal/optic nerve assessments. Biometric measurements were conducted using Pentacam AXL and IOL Master devices. Skilled operators, blinded to each other's results, performed measurements, and devices were employed randomly. Data were analyzed using SPSS version 23.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eBased on the Kolmogorov-Smirnov test of normality, the distribution of data was assessed. If the distribution was normal, a parametric Paired Sample T-test was applied for dependent samples; otherwise, a non-parametric Wilcoxon test was used. The Bland-Altman plot was employed to visually represent the level of agreement between the two methods.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eA total number of 21 patients with intracorneal ring implantation who underwent ICRS implantation surgery from 1392 to 1400 at Khalili Educational and Medical Center in Shiraz, Iran were selected randomly based on inclusion criteria. Among these patients, 10 were female (47.6%) and 11 were male (52.4%); more than half of them had ICRS implantation surgery on their left eye (n\u0026thinsp;=\u0026thinsp;12, 57.1%) while the remaining had the surgery on their right eye (n\u0026thinsp;=\u0026thinsp;9,42.9%). The mean age of the subjects was 35.47(\u0026plusmn;\u0026thinsp;6.43) years; The eldest one was 47 years old while the youngest one was 22 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of 21 subjects\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValues\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age; year\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex; n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(52.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSD: standard deviation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Kolmogorov-Smirnov test was employed to assess the normal distribution of quantitative data. Based on the result of the normality test, the Paired Sample T-test was utilized to compare the means between the values obtained from two devices if the results had normal distribution; whereas the Wilcoxon test was used for data that did not have a normal distribution. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents means of AL, ACD, KM, K1, K1 Meridian, K2, K2 Meridian, White-White distance, IOL power (Haigis), and IOL power (SRK/T) in IOL Master700 versus Pentacam AXL totally and it is also based on eye and gender separately. P-values less than 0.05 are considered statistically significant. Among these variables, ACD, KM, K2, and WTW showed significant differences between the two devices we studied (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). All these four mentioned variables also had significant differences in the left eye (OS). However, no statistically significant difference was reported among all the variables reviewed in this study in the right eye (OD) (p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). According to the classification, KM and K1 with p-values of (0.002, 0.005) which indicates significance differed only in the female group while both male and female groups significantly differed regarding ACD and K2 (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Results did not bring significant changes in other parts of this study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of AL, ACD, KM, K1, K1 Meridian, K2, K2 meridian, White-White distance IOL power (Haigis), and IOL power (SRK/T) between IOL Master 700 and Pentacam AXL totally and among eye and sex group of 21 patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIOL Master700\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePentacam AXL\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDifference between the two devices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK1 Mer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.00\u0026thinsp;\u0026plusmn;\u0026thinsp;26.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.25\u0026thinsp;\u0026plusmn;\u0026thinsp;29.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.33\u0026thinsp;\u0026plusmn;\u0026thinsp;28.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.67\u0026thinsp;\u0026plusmn;\u0026thinsp;29.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.89\u0026thinsp;\u0026plusmn;\u0026thinsp;24.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.73\u0026thinsp;\u0026plusmn;\u0026thinsp;36.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.30\u0026thinsp;\u0026plusmn;\u0026thinsp;17.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.90\u0026thinsp;\u0026plusmn;\u0026thinsp;19.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK2 Mer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126.00\u0026thinsp;\u0026plusmn;\u0026thinsp;26.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125.25\u0026thinsp;\u0026plusmn;\u0026thinsp;29.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125.33\u0026thinsp;\u0026plusmn;\u0026thinsp;28.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128.67\u0026thinsp;\u0026plusmn;\u0026thinsp;29.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126.89\u0026thinsp;\u0026plusmn;\u0026thinsp;24.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130.73\u0026thinsp;\u0026plusmn;\u0026thinsp;36.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129.73\u0026thinsp;\u0026plusmn;\u0026thinsp;31.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.30\u0026thinsp;\u0026plusmn;\u0026thinsp;17.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121.90\u0026thinsp;\u0026plusmn;\u0026thinsp;19.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWTW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOL(Haigis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.61\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.32\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.26\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOL(SRK/T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.79\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.95\u0026thinsp;\u0026plusmn;\u0026thinsp;8.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAL: axial length, ACD: anterior chamber depth, KM: mean keratometry, K1: flat keratometry, K2: steep keratometry, WTW: White-White distance, IOL(Haigis): IOL power which was calculated with Haigis formula, IOL(SRK/T): IOL power which was calculated with SRK/T formula, OD: oculus dexter, OS: oculus sinister\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a comprehensive review, various advanced optical biometric tools, including IOLMaster 700, IOLMaster 500, Pentacam AXL, and Sirius are being used at present time. This study focuses on comparing Pentacam AXL and IOLMaster 700 in terms of biometric and keratometry measurements and also IOL power calculation using Haigis or SRK/T formula. The anticipated outcomes of this research could provide valuable insights for clinicians in selecting the most optimal approach for IOL calculation prior to cataract surgery in patients with stable, well-positioned, and successfully implanted intracorneal rings.\u003c/p\u003e \u003cp\u003eAL and corneal keratometry play a crucial role in determining lens prescription. Studies highlight the significance of even a small 0.1 mm change in AL, causing up to 0.27 diopters change in lens measurements. Despite consistent discussions on the alignment between Pentacam AXL and IOL Master 700 in AL measurements, variations exist. Rivero's study showed a difference of 0.0244\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0130, favoring higher values with Pentacam AXL [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Kiraly et al. reported a minimal impact on lens sizing, supporting interchangeability[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our study on the AL index revealed a small discrepancy of 0.03, with no significant difference between the two devices. Shajari et al.'s findings also aligned with our results, indicating negligible differences in AL measurements[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe depth of the anterior chamber influences lens power specifically; a 1 mm change can result in a 1.44 diopter alteration[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Inconsistencies in ACD measurements between Pentacam AXL and IOL Master 700 are noted, with Pentacam often providing higher values. Our study found a significant ACD difference of 0.07, consistently favoring Pentacam AXL. Literature suggests potential interchangeability between the devices, acknowledging slight differences in ACD measurements [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Despite discrepancies, Savant et al. and Woodmass and Rocha found no statistically significant differences in any index between the devices[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccurate WTW measurement is essential for determining the size of implantable Collamer lenses. Discrepancies between Pentacam AXL and IOL Master devices have been observed, with IOL Master often reporting larger values. Salouti et al. cautioned against substituting one device for the other [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Our study found a significant difference in the WTW index, with IOL Master 700 calculating a higher WTW distance on average. Sayed et al.'s findings supported shorter WTW line measurements with Pentacam compared to IOL Master, emphasizing the importance of careful interpretation[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn summary, while certain measurements demonstrate potential interchangeability between Pentacam AXL and IOLMaster 700, caution is advised considering differences across specific parameters. The device selection may depend on the clinical context and the specific measurements required for accurate lens sizing and prescription.\u003c/p\u003e \u003cp\u003eIn a comprehensive review, studies assessing interchangeability between Pentacam AXL and IOLMaster 700 reveal variable outcomes across parameters. Mustafa Aksoy et al support interchangeability for IOLMaster 700 K and Pentacam EKR 4.5 mm measurements[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Our study aligns, finding no significant differences in SRK/T and Haigis formula, but a significant Km index disparity. Soltani Moghadam et al. (2017) emphasize correlations in Pentacam indices related to keratoconus, highlighting max K, mean K and corneal astigmatism having the most correlation between anterior and posterior elevation differences [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Li et al. (2020) report good compatibility for AL, ACD, and CCT but limited one for WTW and Km interchangeability [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Reuland et al. (2019) suggest Pentacam as a biometric device with comparable keratometry measurements to IOLMaster[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Wang et al. (2019) demonstrate agreement among Pentacam AXL, IOLMaster 700, and IOLMaster 500 in cataract patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Haddad et al. (2020) note similar AL and K constant measurements but statistical ACD, slope K, and mean K differences between IOLMaster 500 and Pentacam AXL[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Caution is advised, considering parameter-specific variations in device selection for clinical contexts[\u003cspan additionalcitationids=\"CR34 CR35 CR36\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study acknowledges limitations such as the absence of entirely similar studies and a small statistical population. To improve confidence in the results and enhance generalizability, the researchers emphasize the need for more extensive studies with a broader participant base. The study's limitations include a restricted number of patients who underwent intracorneal ring implantation, and this is attributed to the scarcity of patient records and the excessive costs associated with such procedures. To overcome these limitations, future research should aim for larger and more diverse samples to ensure more robust and widely applicable conclusions. The next limitation of the study is that we solely compared the results of intraocular lens (IOL) calculation among different formulas without accompanying data on postoperative outcomes. Consequently, we cannot definitively ascertain the superiority of one method over another. Our conclusions are confined to the level of agreement observed between the various methods of IOL calculation. Therefore, this study primarily serves as an initial assessment of agreement among different methods, and further investigations incorporating post-surgical outcomes are essential to establish the optimal method. Furthermore, a limitation stems from the absence of comprehensive details regarding the post-operative functional outcomes of patients, such as visual acuity and satisfaction. This lack of information may constrain our ability to thoroughly analyze the impact of these factors on the study outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research compares eye biometric data obtained from Pentacam AXL and IOL Master 700 in patients who underwent intracorneal ring implantation. These patients, who may have residual refractive errors or cataracts, are at risk of miscalculations affecting intraocular lens power calculations. The study reveals a significant difference between the two devices in the anterior chamber depth (ACD) index in the left eye and in both genders, keratometry (KM) index in the female gender and in the left eye, K1 index in the female gender, K2 index in the left eye and in both genders and white-to-white (WTW) index in the left eye. Despite these statistically significant differences, the study emphasizes that the clinical impact on intraocular lens power calculation is negligible. Consequently, eye biometric data from both devices can be interchangeably used in determining intraocular lens numbers for cataract surgery in these patients. In other investigated cases, no significant differences were observed between the two devices.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eConflict of Interest:\u003c/strong\u003e \u003cp\u003eShahram Bamdad, and Mohammadreza Khalili; Amirmohammad Fathian, and Alireza Attar declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of The Human Ethics Committee of Shiraz University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. the participants in the study were fully informed about the goals, cooperation, benefits, and potential harms of the study and completed the ethical consent forms.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eAll authors have read and approved the final version of the manuscript and agree to its submission to Journal of Ophthalmic Inflammation and Infection. The authors also consent to the publication of the manuscript in the journal and affirm that the work is original, has not been published previously, and is not under consideration for publication elsewhere.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eShahram Bamdad, and Mohammadreza Khalili; Amirmohammad Fathian, and Alireza Attar declare that they have no competing interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThe authors received no funding for the study from any organization.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eData was gathered by alireza attar; drafting by Alireza Attar, Shahram Bamdad, and Mohammadreza Khalili; analysis by Amirmohammad Fathian; and revision completed by Alireza Attar.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003en/a\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAsbell PA et al. \u003cem\u003eAdjustability of refractive effect for corneal ring segments.\u003c/em\u003e (1081-597X (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchanzlin DJ et al. \u003cem\u003eThe intrastromal corneal ring segments. Phase II results for the correction of myopia.\u003c/em\u003e (0161\u0026ndash;6420 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNos\u0026eacute; W et al. \u003cem\u003eIntrastromal corneal ring: 12-month sighted myopic eyes.\u003c/em\u003e (1081-597X (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColin J, Velou S. Curr Surg options keratoconus. 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Koh, \u003cem\u003eSequential intrastromal corneal ring implantation and cataract surgery in a severe keratoconus patient with cataract.\u003c/em\u003e (2092\u0026ndash;9382 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoramnia RA-O et al. \u003cem\u003eRefractive Outcomes after Cataract Surgery. LID \u0026ndash;\u0026thinsp;10.3390/diagnostics12020243 [doi] LID \u0026ndash;\u0026thinsp;243.\u003c/em\u003e (2075\u0026ndash;4418 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlsen T. \u003cem\u003eImproved accuracy of intraocular lens power calculation with the Zeiss IOLMaster.\u003c/em\u003e (1395\u0026ndash;3907 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantodomingo-Rubido J et al. A new non-contact optical device for ocular biometry. (0007\u0026ndash;1161 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaad E, Shammas MC, Shammas HJ. \u003cem\u003eScheimpflug corneal power measurements for intraocular lens power calculation in cataract surgery.\u003c/em\u003e (1879\u0026ndash;1891 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawamorita T et al. Repeatability, reproducibility, and agreement characteristics of rotating Scheimpflug photography and scanning-slit corneal topography for corneal power measurement. J Cataract Refractive Surg, 2009. 35(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorasio E, Stevens GT, Fau - J, Smith, Smith GT. \u003cem\u003eEstimation of true corneal power after keratorefractive surgery in eyes requiring cataract surgery: BESSt formula.\u003c/em\u003e (0886\u0026ndash;3350 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSymes RJ, Ursell PG. \u003cem\u003eAutomated keratometry in routine cataract surgery: comparison of Scheimpflug and conventional values.\u003c/em\u003e (1873\u0026ndash;4502 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWegener A, Laser-Junga H. \u003cem\u003ePhotography of the anterior eye segment according to Scheimpflug's principle: options and limitations - a review.\u003c/em\u003e (1442\u0026ndash;9071 (Electronic)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeitz B, Langenbucher A. \u003cem\u003eIntraocular lens calculations status after corneal refractive surgery.\u003c/em\u003e (1040\u0026ndash;8738 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRetzlaff JA. M.C. Sanders Dr Fau - Kraff, and M.C. Kraff, \u003cem\u003eDevelopment of the SRK/T intraocular lens implant power calculation formula.\u003c/em\u003e (0886\u0026ndash;3350 (Print)).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoramnia R, et al. Refractive outcomes after cataract surgery. Diagnostics. 2022;12(2):243.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiraly L et al. \u003cem\u003eRepeatability and agreement of central corneal thickness and keratometry measurements between four different devices.\u003c/em\u003e Journal of ophthalmology, 2017. 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShajari M, et al. Comparison of axial length, corneal curvature, and anterior chamber depth measurements of 2 recently introduced devices to a known biometer. Am J Ophthalmol. 2017;178:58\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong J, et al. Comparison study of the two Biometers based on swept-source Optical Coherence Tomography Technology. Diagnostics. 2022;12(3):598.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUtine CA, et al. Comparison of anterior chamber depth measurements taken with the Pentacam, Orbscan IIz and IOLMaster in myopic and emmetropic eyes. Acta Ophthalmol. 2009;87(4):386\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDinc UA, et al. Assessment of anterior chamber depth using Visante optical coherence tomography, slitlamp optical coherence tomography, IOL Master, Pentacam and Orbscan IIz. Ophthalmologica. 2010;224(6):341\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElbaz U, et al. Comparison of different techniques of anterior chamber depth and keratometric measurements. Am J Ophthalmol. 2007;143(1):48\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu P-F, et al. 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Cornea. 2017;36(11):1373\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumeister M, et al. Comparison of manual and automated methods to determine horizontal corneal diameter. J Cataract Refractive Surg. 2004;30(2):374\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalouti R, et al. Comparison of horizontal corneal diameter measurements using Galilei, EyeSys and Orbscan II systems. Clin Experimental Optometry. 2009;92(5):429\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAksoy M, et al. Comparison of refractive outcomes using Scheimpflug Holladay equivalent keratometry or IOLMaster 700 keratometry for IOL power calculation. Int Ophthalmol. 2021;41:2205\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoltani Moghadam R, et al. Pentacam Indices Affecting Elevation Difference of Cornea in Patients with Mild and Moderate Keratoconus. Bina J Ophthalmol. 2018;23(3):182\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI D et al. Agreement of biometry parameters measured by IOLMaster 700 and Pentacam AXL in cataract eyes. Chin J Experimental Ophthalmol, 2020: pp. 962\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReuland MS et al. \u003cem\u003eCorneal radii and anterior chamber depth measurements using the IOLmaster versus the Pentacam\u003c/em\u003e. 2007, Slack Incorporated Thorofare, NJ. pp. 368\u0026ndash;373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Z, et al. \u003cem\u003eComparison of biometry with the Pentacam AXL, IOLMaster 700 and IOLMaster 500 in cataract patients.\u003c/em\u003e [Zhonghua yan ke za zhi]. Chin J Ophthalmol. 2019;55(7):515\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad JS et al. Comparison of biometry measurements using standard partial coherence interferometry versus new Scheimpflug tomography with integrated axial length capability. Clin Ophthalmol, 2020: pp. 353\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Biometry, Intracorneal ring segments implantation (ICRS), IOL Master 700, Pentacam AXL","lastPublishedDoi":"10.21203/rs.3.rs-5448784/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5448784/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e \u003cp\u003eThis study aims to compare eye biometrics data obtained from Pentacam AXL and IOL Master 700 in patients who underwent intracorneal ring segments implantation. The focus is on assessing the interchangeability of these devices for intraocular lens power calculations, crucial for effective cataract surgery in individuals with corneal ectasia.\u003c/p\u003e\u003ch2\u003eMethod:\u003c/h2\u003e \u003cp\u003eTwenty-one eligible patients, post intracorneal ring segments implantation at Khalili Hospital, underwent pre-surgery examinations and biometrics measurements using Pentacam AXL and IOL Master 700. The devices were employed randomly and expert operators, blinded to each other's results, conducted the measurements. Data were analyzed using SPSS version 23 with statistical analysis performed using parametric and non-parametric tests based on the distribution of quantitative variables.\u003c/p\u003e\u003ch2\u003eResult:\u003c/h2\u003e \u003cp\u003eSignificant differences were observed in anterior chamber depth (ACD), mean keratometry (KM), K2, and white-to-white (WTW) measurements between Pentacam AXL and IOL Master 700, particularly in the left eye. While ACD and K2 showed significant differences in both male and female groups; similar results have been reported for KM and K1 only in the female group.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eDespite the differences, the study concludes that the clinical impact on intraocular lens power calculation is negligible. Eye biometric data from both devices can be interchangeably used for determining intraocular lens numbers in patients with intracorneal ring segments implantation undergoing cataract surgery. The study emphasizes caution in considering parameter-specific variations and calls for broader studies to enhance generalizability.\u003c/p\u003e","manuscriptTitle":"Biometric and keratometry parameters after intracorneal ring segments implantation: A comparison between Pentacam AXL and IOL Master 700","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 11:36:23","doi":"10.21203/rs.3.rs-5448784/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-22T13:34:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-19T12:36:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-19T12:34:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-11-13T17:12:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6c23c22-4c38-4078-8376-96c701d8b17b","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:04:59+00:00","versionOfRecord":{"articleIdentity":"rs-5448784","link":"https://doi.org/10.1186/s12886-025-03914-2","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-02-18 15:56:56","publishedOnDateReadable":"February 18th, 2025"},"versionCreatedAt":"2024-12-19 11:36:23","video":"","vorDoi":"10.1186/s12886-025-03914-2","vorDoiUrl":"https://doi.org/10.1186/s12886-025-03914-2","workflowStages":[]},"version":"v1","identity":"rs-5448784","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5448784","identity":"rs-5448784","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}