Preoperative Keratometric Power as the Primary Biometric Determinant of Thirty-Day Visual Rehabilitation Following Phacoemulsification: A Retrospective Cohort Study in West Sumatra, Indonesia

Abstract

Background: Visual recovery after phacoemulsification depends on accurate preoperative biometry. The influence of corneal curvature in eyes with normal axial dimensions remains uncertain. Objective: To assess associations between axial length (AL), anterior chamber depth (ACD), keratometry (K), and 30-day postoperative visual outcomes in West Sumatra, Indonesia. Methods: This retrospective cohort included 51 consecutive patients (51 eyes) undergoing uncomplicated phacoemulsification with posterior chamber intraocular lens implantation during May–July 2025. Preoperative immersion A-scan biometry and automated keratometry were recorded. Best-corrected visual acuity (BCVA) at 30 days was categorized using WHO criteria. Spearman correlation and multivariable logistic regression were performed. Result: Mean age was 65.55 ± 8.12 years; 52.94% were female. Mean AL, ACD, and K were 23.57 ± 1.19 mm, 2.92 ± 0.34 mm, and 43.62 ± 1.46 D. At 30 days, 15.69% achieved emmetropia, 76.47% had mild impairment, and 7.84% had moderate impairment. Keratometry correlated with BCVA (r = −0.280, p = 0.046); AL (p = 0.249) and ACD (p = 0.592) did not. Physiological keratometry (43.00–44.50 D) independently predicted favorable rehabilitation (adjusted OR 3.84, 95% CI 1.18–12.50; p = 0.026). Conclusion: Preoperative keratometry was the principal biometric predictor of 30-day visual recovery in this cohort. Standardized keratometry and appropriate intraocular lens formulas may reduce refractive surprises.