Refractive Surprise In A Patient Who Underwent Cataract Surgery, Secondary To Changes In Corneal Biomechanics. Case Repoert
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT615 | Type: Free paper | DOI: 10.82333/aey4-nb90
Authors: Dr Justo Luís Noriega Martínez* 1 , A/Prof. Andrés Pablo Noriega Martínez 2 , Dr Alexeide de la C. Castillo Pérez 3 , Dr Raúl Humberto Plasencia Salini 4 , Dr Jhony Sandro Castañeda Rojas 5
1Oftalmología,Instituto Superior de Ciencias Médicas de Santiago de Cuba,Manzanillo,Cuba;Córnea,Cornea-Cuantica YJC,Lima,Peru, 2Topografía,Instituto Superior Pedagógico,Manzanillo,Cuba;Topografía,Cornea-Cuantica YJC,Lima,Peru, 3Oftalmología,Instituto Superior de Ciencias Médicas de La Habana,La Habana,Cuba;Córnea,Instituto Cubano de Oftalmología "Ramón Pando Ferrer",La Habana,Cuba, 4Oftalmología, Universidad de San Martin de Porres,Trujillo,Peru;Córnea,CorneaClinic,Trujillo,Peru, 5Oftalmología, Universidad de San Martin de Porres,Lima,Peru;Glaucoma,Clínica de Ojos Ñahui,Lima,Peru
Purpose
The entry incisions in the cornea during cataract surgery on a cornea with ectatic changes induce high-order aberration astigmatism, especially those that do not correspond to the location of the tomographic meridian to be treated, which is extremely important to avoid creating astigmatism that did not exist, inducing an increase in existing astigmatism, or reactivating a process that had previously stopped. The entry into the anterior chamber through the clear corneal incision, combined with the energy effect generated by the ultrasound through the microinstrument, causes an imbalance in the stress-strain relationship both in tension and shear, impacting the corneal tissue volume over time.
Setting
The goal of cataract surgery is to restore as much vision and quality of vision as possible in patients, it's not enough to simply recover their eyesight, it is common to see patients who have undergone cataract surgery with 20/20 visual acuity, but are dissatisfied with the quality of their visión, higher-order aberrations, although not common, are decisive in visual quality. Secondary astigmatisms from surgeries induce high-order aberrations, specifically fourth-order aberrations.
Methods
Case Repoert:
72-year-old female patient with a health history of cataract surgery in both eyes, now she comes to our clinic for start visual difficulties due to loss of depth, unable to define faces accurately, with limitation of night vision, which prevents him from developing his normal activity, this picture appears after cataract surgery in the right eye, second eye operated.
Key words: Refractive surprise, asphericity, spherical aberration
Results
Pre-op: VA without glasses: OD (0.12)/OS(0.2). RD OD -3.00 - 0.50x1400(0.25+1) OI -1.00 -0.50x500(0.5).
First post–op: VA without glasses: OD (0.5 )/OS (0.2). RD OD -0.75 -0.25x1650 (1.0) OI +1.00 -3.00x1740(0.4)
We worked on the already modified cornea, carrying out the new surgical plan based on the new corneal architecture, trying not to alter its current asphericity (Q factor) the final result.
VA without glasses: OD (0.5)/OI (0.6). RD: OD -0.75 -0.25x1650 (1.0) OI - 0.25 – 0.75x1830(1.0)
Conclusions
Evaluating, combining and using the values of the KPD TCRP 4 mm histogram from the PENTACAM AXL and the biometric results from the IOL Master 700 / Argus System, along with selecting the correct formula, led us to the results obtained.