Refractive Outcomes Following Cataract Surgery In Eyes With Previous Laser Refractive Surgery: A Retrospective Audit And Learning Points
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT589 | Type: Poster | DOI: 10.82333/j082-4h73
Authors: Mr Amit Dhalla* 1 , Mr Palaniappan Muthiah 2 , Ms Jennifer Tan 1
1Ophthalmology,Royal Hallamshire Hospital,Sheffield,United Kingdom, 2University,Sheffield University,Sheffield,United Kingdom
Purpose
To evaluate refractive outcomes following routine cataract surgery in patients with prior laser refractive surgery and to identify key learning points related to intraocular lens (IOL) calculation and documentation.
Setting
A major teaching hospital in the North of England.
Methods
A retrospective audit was performed of patients with previous laser refractive surgery who underwent cataract surgery between August 2014 and September 2025. A total of 289 eyes were included. Post-operative prediction error (deviation from predicted post-operative refraction, PPOR) was analysed overall and also according to the type of prior laser correction and IOL power calculation formula where documented.
Results
Across all eyes, deviation from PPOR ranged from -2.50 D to +2.37 D, with a mean deviation of -0.11 D. Overall, 250 of 289 eyes (86.5%) achieved a refractive outcome within ±1.00 D of the predicted refraction. The type of prior laser procedure was unknown in 96 eyes. Among cases with known indication, 155 eyes had previous myopic laser correction (PPOR range -2.50 D to +2.37 D, mean -0.12 D) and 38 eyes had previous hyperopic correction (PPOR range -1.66 D to +1.31 D, mean -0.28 D). Where the IOL calculation formula was clearly documented in the electronic record, the two most commonly used formulae were Barrett True-K (83 eyes, PPOR range -2.50 D to +1.38 D, mean -0.25 D) and SRK/T (93 eyes, PPOR range -2.21 D to +2.37 D, mean +0.15 D).
Conclusions
Cataract surgery in patients with prior laser refractive surgery can achieve good refractive outcomes, with most eyes within ±1.00 D of PPOR. Accurate identification of prior laser treatment remains essential for correct IOL calculation. Many patients were uncertain of their previous procedure, highlighting the need for careful biometric review, corneal imaging, and clear documentation to reduce refractive surprises. Learning points included a case where prior hyperopic laser was mistaken for myopic laser, leading to incorrect IOL implantation, and a near miss where biometric findings inconsistent with presumed myopic laser prompted reassessment before surgery. We will include these cases with supporting data as key learning points.