Impact of Posterior Staphyloma and Peripheral Refraction on Intraocular Lens Power Calculation in Highly Myopic Eyes

Purpose To assess the impact of posterior staphyloma and peripheral refraction on the calculation of intraocular lens (IOL) power in eyes with highly myopic cataracts. Methods Multispectral refraction topography (MRT) was used to categorize posterior staphyloma types and detect the refraction difference value (RDV) across different fundus regions. The Barrett Universal II formula was employed for IOL power calculation. Refractive outcomes were assessed through the calculation of standard deviation (SD), mean absolute error (MAE), median absolute error (MedAE), and the proportion of eyes with prediction error (PE) within ±0.25, ±0.50, ±0.75, and ±1.00 diopters (D). The associations between PE and peripheral refraction were analyzed using Pearson correlation analysis. Results A total of 65 patients (84 eyes) were included in the study and were categorized into groups based on staphyloma types (non-posterior staphyloma, wide macular staphyloma, narrow macular staphyloma, peripapillary staphyloma) using MRT. The patients with wide macular staphyloma exhibited significantly higher SD (0.465) in comparison to those without staphyloma (0.23). Among patients with posterior staphyloma, peripapillary staphyloma had the least effect on IOL power calculation with the lowest SD (0.325), MAE (0.25), and MedAE (0.25), and highest percentage of cases with a PE within ±0.50 D (90%). According to multivariate analysis, RDV-Superior was significantly correlated with PE (B = −0.471, P = .001). Conclusions Patients with wide macular staphyloma present challenges for accurate IOL power calculation. In addition, superior retinal peripheral myopic defocus in patients with posterior staphyloma may lead to greater hyperopic shifts after cataract surgery. Consideration of staphyloma types and RDV-Superior is recommended for more precise IOL power calculation. [ J Refract Surg . 2025;41(5):e472–e480.]