Late refractive change after cataract extraction and toric intraocular lens implantation

To report rates of change and identify factors associated with late change in refractive outcome after toric intraocular lens (TIOL) implantation.

Single-site study at the Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.

Retrospective cohort study.

Study inclusion required uncomplicated posterior chamber Alcon SN6ATT TIOL implantation from 2010 to 2017 and refractions 1 month and 5 years postoperatively. Exclusion criteria were sulcus IOL placement, subsequent intraocular or refractive surgery in the operative eye, and 5-year Snellen visual acuity of 20/60 or worse. Outcomes of interest were change in spherical equivalent (SE) and change in magnitude of the astigmatism vector between the postoperative month 1 and postoperative year 5 refractions. Refractive stability was defined as ≤0.5 diopter (D) change in SE and ≤1 D change in magnitude of the astigmatism vector. Predictive factors analyzed included age, sex, race, pseudoexfoliation (PXF) syndrome, axial length (AL), preoperative keratometry measurements (∆K), IOL power, neodymium:yttrium aluminum garnet capsulotomy, and intravitreal injections.

Of the 320 eyes meeting study criteria, SE was stable in 241 (75%) eyes, astigmatism was stable in 266 (83%) eyes, and 205 (64%) eyes met criteria for refractive stability with both measures. Multivariable regression analysis identified shorter AL ( P = .018) and larger ∆K ( P = .002) as significant predictors of change in refractive astigmatism and PXF syndrome ( P = .006) as a predictor of hyperopic shift >0.5 D.

A minority of eyes exhibit late refractive change after TIOL implantation. AL, ∆K, and PXF syndrome are independent predictors of late refractive change.