Six-Month Refractive Outcomes And Iol Position Changes In Cataract Surgery.

Achieving a postoperative refractive outcome as close as possible to the target is crucial in cataract surgery, as residual astigmatism and refractive errors impact visual quality and patient satisfaction. This study evaluates the correlation between preoperative target refraction, postoperative intraocular lens (IOL) shift, and long-term refractive outcomes.

The study was conducted at the Clinical Hospital Centre Sestre Milosrdnice in Zagreb, Croatia. This was a prospective, observational study involving patients undergoing routine cataract surgery with monofocal IOL implantation.

The study included patients who underwent routine phacoemulsification with clear corneal incisions and implantation of a foldable monofocal IOL. Preoperative measurements included biometry, anterior chamber depth (ACD), axial length (AL), central corneal thickness (CCT), white-to-white (WTW) distance, and pupil size. Three types of IOLs were implanted in the study: PCB00 (Johnson & Johnson), RayOne (Rayner) and Akreos Adapt (Bausch & Lomb). The target postoperative refraction was set between -0.75 D and 0.00 D. IOL position (Pentacam, Oculus) and refraction were assessed at 1 week, 1 month, and 6 months postoperatively, with a focus on IOL shift and refractive stability. Patient satisfaction was also evaluated.

A total of 90 eyes from 90 patients were analyzed. No significant differences were found between the groups regarding age, gender, preoperative biometric parameters, or target refraction. IOL position was assessed using Pentacam at 1 week, 1 month, and 6 months postoperatively. No significant IOL shifts were observed. The smallest shift was in the PCB00 and RayOne groups, while Akreos Adapt showed a slight hyperopic shift. By 6 months, all IOLs demonstrated good stability with a mean shift of 0.27 ± 0.06 mm. At 6 months, the mean postoperative spherical equivalent was -0.21 ± 0.09 D. Most patients achieved refractive outcomes within ±0.50 D of the target. All IOLs showed good long-term stability.

In conclusion, target refraction to achieve emmetropia is influenced by the type of intraocular lens (IOL) implanted. For the PCB00 and RayOne lenses, aiming for a slight myopic or emmetropic target refraction is recommended to achieve emmetropia, while for the Akreos Adapt lens, a minor myopic target refraction is preferred. In routine cataract surgery with monofocal IOL implantation, the most significant IOL and refractive shifts occur within the first month postoperatively, with minimal changes observed thereafter. Overall, all IOLs demonstrated good stability, with most patients achieving a refractive outcome close to the intended target.