Cataract Surgery Following Refractive Surgery: Principles for Success

As the number of cataract patients with a history of corneal refractive surgery continues to rise, it is necessary to understand how to appropriately manage their surgical outcomes. These cases are uniquely complex due to altered corneal optical properties, reduced predictability in intraocular lens (IOL) power calculations, and higher visual expectations. This review outlines key principles for optimizing refractive accuracy and patient satisfaction in this population. Topics include preoperative corneal imaging interpretation, current IOL power calculation strategies (including modern formulas and ray tracing software), management of astigmatism, and IOL selection based on aberration profile. We also evaluate the role of presbyopia-correcting IOLs, including light-adjustable, trifocal, extended depth of focus, and small-aperture options. Through a comprehensive synthesis of recent evidence and expert recommendations, this review provides practical guidance for surgeons to achieve successful outcomes of cataract surgery in post-refractive eyes.