Stabilization of refractive error and associated factors following small incision phacoemulsification cataract surgery

Abstract

Background Accumulating evidence suggests that refractive stabilization occurs rapidly following small incision cataract surgery. Nonetheless, many guidelines still suggest waiting four to 6 weeks before prescribing corrective lenses. This study was undertaken to supplement the existing literature regarding refractive stabilization, and evaluate multiple contributing factors that could dissuade clinicians from confidently correcting refractive error in the early post-operative course following routine cataract surgeries. Methods Adult patients undergoing phacoemulsification cataract surgery with uncomplicated surgeries and post-surgical courses at the Calgary Ophthalmology Centre (Calgary, Alberta, Canada) were included in this prospective observational case series. Exclusion criteria included known corneal dystrophies, infectious keratitis, complicated surgery or toric/multifocal IOLs. Data was collected at weekly intervals for a total of 6 weeks. Collected data included autorefraction, visual acuity, corneal pachymetry, and effective lens position. Results One hundred six eyes of 104 patients were included in this study. Post-operative sphere, cylinder and spherical equivalent were not significantly different at any post-operative week compared with week six, and 80–86% of patients were within 0.5D of last follow-up spherical equivalent at any week. The secondary outcomes of central corneal thickness, effective lens position and visual acuity did, however, exhibit significant differences between early post-operative weeks and last follow-up values. Conclusions These data suggest that refractive error can be effectively measured and corrected as early as one-week post-operatively in the majority of patients, though other measures of post-operative stability including central corneal thickness, effective lens position and visual acuity can require up to 4 weeks to stabilize. Thus a conservative and pragmatic approach may be to wait until 4 weeks post-operatively prior to obtaining refractive correction following uncomplicated phacoemulsification cataract surgery.

Evaluation of Cataract Surgery as a Cause of Astigmatism among Patients Undergoing Phacoemulsification and Extracapsular Cataract Extraction at KCMC Hospital

“…This suggests that on average the patient population was refractively stable at 2 nd week and remained so throughout the study duration. These data are consistent with previous reports showing early mean refractive stability in study populations (11).…”

Outcomes of Secondary Intracapsular Intraocular Lens Implantation in Patients following Rhegmatogenous Retinal Detachment

“…Notably, there was a high percentage of macula-off cases (23/20, 76.67%) in this study, which may interfere with the refractive outcomes. Considering only the macula-on subgroup, the ME and MAE were 0.00 ± 0.33 D and 0.25 ± 0.19 D, respectively, comparable to those after an uneventful cataract surgery [35]. Although the mechanism of the macular status affecting the refractive error is unclear, the reduction in the retinal thickness [36] and decreased macular function [37] in macula-off RRD cases have been proposed to interfere with AL measurement [38].…”

Determination of the time of refractive stability after uneventful phacoemulsification in Indian eyes

“…Numerous publications have focused on determining the period required for refraction stabilization after phacoemulsification, aiming to find the most optimal time for prescribing corrective glasses to patients[ 8 , 9 ]. One such investigation was carried out by Berk et al [ 9 ], who studied 1838 eyes that underwent phacoemulsification manually and with a femtosecond laser[ 10 ].…”