Refractive Surprise After Cataract Surgery And Intraocular Lens Mislabelling

Refractive surprise, consisting of 0.5 dioptre or more of non-planned ametropia after cataract surgery may be frustrating for both patient and surgeon. Several studies have tried to reveal risk factors related to the eye’s characteristics or the biometry formulae. The factor of intraocular lens (IOL) mislabelling in relation to its true refractive power has only recently been identified. The purpose of the study is to unveil  -among other factors-the relevance of IOL mislabelling to refractive surprise

Department of Ophthalmology, General Hospital of Lamia, Lamia, Greece

Data from files of 1588 consecutive cataract surgeries performed in adults in the years 2024-2025 were retrospectively analysed.  All surgeries were performed by the same surgeon and biometry was done with Alcon Ocuscan using the SRK-T formula. Dry eye disease, Salzmann's nodular dystrophy, and pterygia were addressed  before performing cataract surgery to optimize the ocular surface, obtain quality preoperative measurements, and  determine the appropriate IOLs. 3 keratometry and 30 axial length measurements were obtained from each eye. Data collected were patient demographics, postoperative refractive status, preoperative eye’s characteristics and type of IOL. Multifactorial analysis was used to identify the significant risk factors.

Previous pterygium surgery and shorter eyes had a higher risk for refractive surprise. There were not statistically significant differences in refractive surprise frequencies in relation to the IOL used. However, there was a male patient with +2.00 D postoperative refractive outcome who after thorough further verification underwent IOL exchange with a different type but same power IOL.

IOL mislabelling is identified as a risk factor of postoperative refractive surprise. Large registries may offer adequate data on this factor and contribute to the quality assessment of various types of IOLs.