Postoperative Intraocular Lens Position and Refractive Stability in Cataract Surgery: Influence of Target Refraction and IOL Design.

Background and

Objectives

Achieving a postoperative refractive outcome close to the target is crucial in cataract surgery, as residual refractive errors can affect visual quality and patient satisfaction.

Methods

This study evaluates the relationship between preoperative target refraction, postoperative intraocular lens (IOL) shift, and refractive stability. Prospective, observational study conducted at the Clinical Hospital Centre Sestre Milosrdnice, Zagreb, Croatia, involving patients undergoing routine cataract surgery with monofocal IOL implantation. Ninety-four eyes undergoing phacoemulsification with implantation of one of three monofocal IOLs (PCB00, RayOne HA, Akreos Adapt) were included. Preoperative biometry assessed axial length, anterior chamber depth, central corneal thickness, and white-to-white distance. Target refraction was -0.75 to 0.00 D. IOL position and refraction were measured at 1 week, 1 month, and 6 months postoperatively. Patient satisfaction was evaluated at all three time points.

Results

All three IOLs demonstrated comparable in-the-bag stability over 6 months, with minimal longitudinal shift (all p > 0.05). Postoperative refractive outcomes were generally comparable, but RayOne HA showed a slightly more myopic deviation, whereas PCB00 and Akreos Adapt remained closer to emmetropia. The differences reflect the extent of deviation from the intended postoperative refraction, with statistically significant intergroup differences at 1 month (p = 0.004) and 6 months (p = 0.045).

Conclusions

All three IOLs provided stable positioning and excellent visual outcomes. However, small differences in refractive predictability suggest that IOL design may influence the accuracy of target refraction. Tailoring target refraction according to IOL type may improve the likelihood of achieving emmetropia and optimize patient satisfaction.