Accuracy Of Refractive Correction Using Iol Exchange For Post-Cataract Refractive Surprise

Refractive precision has become a critical determinant of success in modern cataract surgery, particularly with the increasing use of premium intraocular lenses (IOLs). Even after an uneventful procedure, postoperative refractive error may significantly compromise visual outcomes and patient satisfaction. While corneal refractive surgery is frequently considered, it may induce higher-order aberrations and optical side effects. This study aimed to evaluate the predictability and accuracy of refractive correction using IOL exchange for postoperative refractive surprise.

Single-surgeon retrospective clinical study conducted at a private ophthalmology clinic

This retrospective study included patients who underwent IOL exchange for refractive correction within three years after primary cataract surgery. Only cases involving exchange of the same IOL model for power adjustment were included. Thirty eyes were analyzed, including 15 eyes with previous corneal refractive surgery and 15 eyes without prior ocular surgery. IOL power selection was determined using IOLMaster 700 with the Barrett True-K formula. Refractive prediction error was calculated as the difference between predicted and postoperative spherical equivalent (SE) and incorporated into recalculation.

Thirty eyes were analyzed. The mean refractive prediction error after primary surgery was 0.77 ± 0.51 D. Following IOL exchange, the mean absolute error was 0.23 ± 0.14 D, with 93.3% of eyes within ±0.50 D of target refraction. High refractive accuracy was achieved regardless of prior corneal refractive surgery. MAE was 0.29 ± 0.17 D in post-refractive surgery eyes and 0.18 ± 0.10 D in controls.

Incorporating the initial refractive prediction error into IOL power selection resulted in highly predictable refractive outcomes. IOL exchange provided accurate refractive correction irrespective of prior corneal refractive surgery. As refractive precision becomes increasingly critical in modern cataract surgery, IOL exchange represents a reliable and physiologically favorable strategy for managing postoperative refractive error.