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—Dr Hoffer correctly points out the problem of calculating a proper intraocular lens power when an intraocular lens implantation is coupled with a penetrating keratoplasty either as a triple procedure or as an intraocular lens exchange. Using the average postoperative keratometry reading for an individual surgeon can enhance this prediction,1 but not with the accuracy achieved after cataract surgery. In our article, 95% of the eyes fell within ± 3.50 D of emmetropia, a refractive error acceptable to most individuals who have undergone penetrating keratoplasty with an intraocular lens exchange. Using the preoperative axial length and the average postoperative keratometry reading for an individual surgeon, we previously demonstrated1 that approximately 80% of eyes fall within ± 2.00 D of refractive error and about 92% fall within ±3.00 D. Binder2 recently reported similar results.With these considerations, Dr Hoffer's proposal to perform a penetrating keratoplasty and
Waring GO, Stulting RD. Triple Procedure for Intraocular Lens Exchange-Reply. Arch Ophthalmol. 1987;105(5):609-610. doi:10.1001/archopht.1987.01060050027005