Objective: To research the accuracy of an intraocular lens (IOL) refractive power calculation formula based on total corneal refractive power (TCRP) in calculating the IOL refractive power in cataract patients with an abnormal B/F ratio. Methods: This was a prospective clinically controlled study. Fifty-one cataract patients (51 eyes) with an abnormal corneal B/F ratio were selected consecutively. Patients were divided into two groups: A high B/F ratio group, B/F≥85%, 24 patients (24 eyes), mean=86.2±0.5%; alow B/F ratio group, B/F≤78%, 27 patients (27 eyes), mean=76.6±0.6%. The TCRP measured by the Pentacam (3 mm, pupil center, zone), the axial length (AL) and anterior chamber depth (ACD) measured by the IOL-Master 500 were used in the self-developed IOL refractive power calculation formula. Uncorrected distance visual acuity (logMaR) and optometric testing with a computer were performed 3 months after surgery. Results: The uncorrected distance visual acuity (UCDVA) at 3 months after surgery was 0.19±0.09 in the high B/F ratio group and 0.19±0.08 in the low B/F ratio group. There was no significant difference between the two groups (t=0.787, P=0.435). The mean absolute error (MAE) at 3 months after surgery was 0.38±0.16 D in the high B/F ratio group and 0.42±0.19 D in the low B/F ratio group. Three months after surgery, the MAEs of all patients calculated by the TCRP Method, Higis, HofferQ, SRK-T, and Hollady-Ⅰ formulas were 0.40±0.17 D, 0.64±0.25 D, 0.73±0.27 D, 0.98±0.32 D and 0.84±0.25 D, respectively. The differences in the absolute prediction error (APE) of the five formulas were statistically significant (χ2 =12.47, P=0.023). Furthermore, the APE of the TCRP Method was compared with the Haigis, Hoffer-Q, SRK-T, and Holladay-Ⅰ formulas, and the differences were statistically significant (Z=2.97, 3.53, 4.01, 3.75, all P<0.05). The overall comparisons of the five formulas of the APE were statistically significant for the high B/F ratio group and low B/F ratio group: (χ2 =12.35, P=0.037; χ2 =13.21, P=0.025). Conclusions: For cataract patients with an abnormal B/F ratio, the accuracy of the conventional IOL refractive power calculation formula is poor, and the TCRP-based IOL refractive power calculation formula has high accuracy and perfect UCDVA.