Management of Residual Refractive Error After Cataract Surgery

Jorge L. Alio; Ahmed A. Abdelghany; Roberto Fernández-Buenaga


Curr Opin Ophthalmol. 2014;25(4):291-297. 

In This Article

Abstract and Introduction


Purpose of review: To provide a review of the recent literature on the management of residual refractive error after cataract surgery.

Recent findings: Laser in-situ keratomileusis (LASIK) is the most accurate procedure to correct residual refractive error after cataract surgery. Lens-based procedures, such as intraocular lens (IOL) exchange or piggyback lens implantation, are also possible alternatives in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is not available. In this review, we found that Piggyback IOL were safer and more accurate than IOL exchange.

Summary: Emmetropia is our main target today in modern cataract surgery. Accurate biometric analysis, selection and calculation of the adequate IOL, and modern techniques for cataract surgery all help surgeons to move toward the goal of cataract surgery as a refractive procedure free from refractive error. However, in spite of all these inputs, residual refractive error still occasionally occurs after cataract surgery and LASIK seems to be the most accurate method for its correction.


Phacoemulsification with intraocular lens (IOL) implantation is the most common ophthalmic surgery performed in clinical practice. Its goal is to restore vision affected by different types of cataract. Modern cataract surgery is a refractive procedure and is performed to correct a refractive error such as myopia, hyperopia, and astigmatism especially when associated to a decrease in accommodation.[1–3]

Emmetropia (spherical equivalent −0.5 to + 0.5 D and <1.0 D astigmatism) is the goal in most cataract cases. However, in some national series, this was achieved in only 55% of eyes planned for emmetropia.[4]

We explained the outcomes of refractive lens exchange in myopia and hyperopia, and the frequency of secondary refractive procedure needed in different series[5–10] (see Table 1 and Table 2).

Despite new advances in cataract surgery, unsatisfactory visual outcome as a result of a residual refractive error occasionally occurs. Refractive surprise after cataract surgery is an unpleasant and frustrating situation for both the patient and the physician.

Different surgical techniques are proposed for the correction of the residual refractive error, these being corneal-based surgery (laser refractive surgery) and lens-based procedures (IOL exchange or piggyback IOLs).