ESCRS - PO462 - The Hidden Challenges Of Cataract Surgery In Post-Refractive Eyes. Postoperative Outcomes In Cataract Surgery Patients With A History Of Previous Corneal Laser Refractive Surgery

The Hidden Challenges Of Cataract Surgery In Post-Refractive Eyes. Postoperative Outcomes In Cataract Surgery Patients With A History Of Previous Corneal Laser Refractive Surgery

Published 2025 - 43rd Congress of the ESCRS

Reference: PO462 | Type: Free paper | DOI: 10.82333/d73j-0n46

Authors: Luis Fernandez-Vega Cueto-Felgueroso* 1 , Carlos Lisa 1 , Belén Alfonso Bartolozzi 1 , Jose F. Alfonso 2

1Cornea & Lens,Fernandez-Vega University Institute,Oviedo,Spain, 2Cornea & Lens,Fernandez-Vega University Institute,Oviedo,Spain;Ophthalmology,University of Oviedo,Oviedo,Spain

Purpose

Increasing number of patients with a history of corneal laser refractive surgery are presenting for cataract extraction. The corneal curvature alterations induced by photoablation often lead to inaccuracies in intraocular lens (IOL) power calculation, resulting in residual postoperative refractive error. A long-standing objective in ophthalmic research has been the development of an optimal IOL power calculation formula for post-refractive eyes to mitigate this postoperative complication.

The aim of this study is to present postoperative outcomes of cataract surgery in a cohort of patients with a history of refractive corneal surgery, whose IOL power was determined solely based on current biometric data.

Setting

Eye Centre Prague, Prague, Czech Republic 

Methods

This retrospective study included 69 eyes from 43 patients (24 males, 19 females) who underwent cataract surgery following previous refractive laser surgery. Multifocal IOLs were implanted in 47 eyes, while monofocal IOLs were used in 22 eyes. Patients underwent surgery  from November 2021 to December 2024 were included. Only patients with at least one documented postoperative follow-up examination were included. The final postoperative visual acuity assessment was performed at least one month after cataract surgery. 

Results

The mean postoperative corrected distance visual acuity (CDVA) was 0.024 logMAR in previously myopic patients and 0.030 logMAR in previously hyperopic patients. Although CDVA was better in the myopic group, this difference was not statistically significant. Conversely, the mean spherical equivalent (MSE) was higher in myopes (-0.844 D) compared to hyperopes (-0.658 D), with this difference reaching statistical significance. A postoperative refractive error exceeding ±0.50 D was observed in 14 eyes, while 6 eyes had a residual refractive error beyond ±1.00 D. 

Conclusions

Postoperatively, 90% of patients achieved a mean MSE within ±1.00 D. In some cases, residual refractive error was influenced by factors such as astigmatism, a narrow or decentered ablation zone, or a combination of these elements. Our results regarding postoperative CDVA, uncorrected distance visual acuity (UDVA), corrected near visual acuity (CNVA), and mean SE and MSE are consistent with previously published findings in the field.