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Cataract surgery in patients who previously underwent refractive surgery is notoriously difficult and increasingly common. Intraoperative wavefront aberrometry (IWA) has shown promise in delivering improved refractive outcomes. We examined the refractive results of cataract surgery in this population at a large academic referral hospital.
Nonrandomized, retrospective analysis of post-refractive cataract surgery cases performed at UT Southwestern from January 1, 2015 to December 31, 2017. Patient records were identified using the surgery schedule from this time period. Patients were included if they had a history of any type of refractive surgery and underwent subsequent uncomplicated cataract surgery. Main outcome of interest was deviation of one month post-operative refraction from preoperative target refraction. Patients were excluded if no one month post-operative refraction was available. Other outcomes of interest were incidence of hyperopic surprise and percentage of patients within 0.5 and 1.0 D of refractive goal.
104 eyes from 62 patients were identified. Overall, mean deviation from refractive goal was 0.420 D (SD 0.439, median 0.250). Seventy-five percent of refractive results were within 0.5 D of refractive goal, and 96% were within 1.0 D. Mean deviation from refractive goal for femtosecond laser-assisted and non-laser-assisted surgery was 0.332 D (median 0.250, SD 0.398) and 0.523 D (median 0.375, SD 0.466), respectively (p=0.017). There were no significant differences in terms of first versus second eye operated on. There was a trend towards worse refractive results in patients who previously underwent RK.
High-quality refractive outcomes were obtained using IWA during post-refractive cataract surgery in our population. A large, prospective randomized controlled trial would provide useful information regarding the true efficacy of IWA use during cataract surgery in post-refractive patients.