Cataract Surgery After Refractive Surgery

Ravi H. Patel, MD; Carol L. Karp, MD; Sonia H. Yoo, MD; Guillermo Amescua, MD; Anat Galor, MD, MSPH


Int Ophthalmol Clin. 2016;56(2):171-182. 

In This Article

Management of Refractive Error

Manage Expectations

The need to discuss potential refractive errors and expectations after cataract surgery cannot be overstated. Many patients will recall the speed of recovery and the freedom of corrective lenses after their refractive surgery and may expect the same results if not counseled appropriately. Patients may also request presbyopia-correcting IOLs without fully understanding the risk of glares associated with them, which could be especially problematic given their increased higher order aberrations from previous refractive surgery. In this scenario, it may be beneficial to use IOLs with no aberration or with negative spherical aberration.

Managing Postoperative Refractive Error

Despite the new advances in technology for IOL selection, patients may still have postoperative refractive errors. Small refractive errors can be managed with contact lenses or glasses if the patient is amendable to these therapies. Alternatively, for small amounts of spherocylindrical error, PRK or LASIK can be offered to reach the desired target refraction. For larger amounts of error, or in eyes where further corneal surgery would be contraindicated, piggyback IOL or even IOL exchange can be performed. Patients electing for a piggyback IOL or IOL exchange should be counseled regarding the risk of glaucoma, inflammation, and retinal tears.