Surgical options for correcting refractive surprise after cataract and lens surgery: review and meta-analysis

To compare the outcomes of surgical approaches to correct ametropia after cataract and lens surgery.

Despite advancements in the field of biometry and intraocular lens (IOL) power calculation formulas, complete elimination of refractive surprises after cataract and lens surgery is impossible. Preferred Practice Patterns acknowledges the possibility of refractive surprise after cataract surgery; however, no recommendations regarding the preferred treatment have been given.

PubMed and Scopus were used to search the literature as of November 14, 2024. For the statistical analysis, the surgical options were divided into (1) corneal refractive surgery and (2) supplementary IOL implantation. Studies regarding IOL exchange have been mentioned; however, due to the insufficient total number of eyes, they were not included in the meta-analysis. Outcomes included postoperative spherical equivalent (SE) in diopters, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) expressed as logMAR.

The postoperative SE was significantly better in eyes after corneal refractive surgery (0.02; 95% CI -0.06 to 0.10) than after supplementary IOL implantation (-0.21; 95% CI -0.77 to 0.36; P < .0001). Furthermore, the postoperative UDVA was better after corneal refractive surgery (0.04; 95% CI -0.03 to 0.10), than after supplementary IOL implantation (0.12; 95% CI -0.03 to 0.28; P < .0001). Similarly, the postoperative CDVA was better after corneal refractive surgery (-0.01; 95% CI -0.06 to 0.04) than after supplementary IOL implantation (0.06; 95% CI -0.07 to 0.18; P < .0001).

Corneal refractive surgery resulted in superior SE, UDVA, and CDVA, and should be considered the primary approach for treating refractive surprise after cataract and lens surgery.