Astigmatic Refractive Outcomes After Cataract Surgery: A Retrospective Analysis Over 15 Years In A Central London Teaching Hospital

Patient satisfaction is closely linked to refractive outcomes, particularly whether patients achieve independence from glasses post-surgery. Post-operative cylinder (Cyl) is influenced by various factors such as wound construction, incision length, and the meridian operated on. This study evaluates refractive outcomes following cataract surgery using retrospective data from a central London teaching hospital.

Central London teaching hospital, United Kingdom.

Data were collected for cataract surgeries performed over a 15-year period. Only cataract surgeries performed in isolation were included. Combined surgeries were excluded. Patients with sutured wounds and those who received toric intraocular lenses were also excluded, as these factors could influence residual cylinder. Incision length and location, recorded in the operative note, along with baseline demographics, biometry, lens type, and complications, were analysed. Descriptive statistics were used to evaluate refractive outcomes.

A total of 16,045 cases with recorded incision lengths and pre- and post-operative refractions were included in the analysis. Incision lengths ranged from 1 to 15 mm. The median pre-operative cylinder was -1.00D, and the median post-operative cylinder was -0.75D. The mean residual cylinder was 1.06D, with a median of 0.5D. Change in cylinder post operatively was found to be significantly correlated to incision length (p<0.001). No significant correlation was observed between incision length and post operative spherical equivalent (p=0.710). No significant difference in residual cylinder was observed between residents (-0.075 D, 95% CI: -0.103 to -0.048) and consultants (-0.084 D, 95% CI: -0.126 to -0.043), p = 0.723.

These findings highlight that incision length influences residual cylinder, albeit with limited clinical relevance. Further research is needed to explore additional surgical factors and their interplay with refractive outcomes, with the aim of developing tailored approaches to improve patient satisfaction and optimize visual independence post-surgery.