Late refractive change after cataract extraction and toric intraocular lens implantation.

Purpose: To report rates of change and identify factors associated with late change in refractive outcome after toric intraocular lens (TIOL) implantation.

Setting: Single-site study at the Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.

Design: Retrospective cohort study.

Methods: Study inclusion required uncomplicated posterior chamber Alcon SN6ATT TIOL implantation from 2010 to 2017 and refractions 1 month and 5 years postoperatively. Exclusion criteria were sulcus IOL placement, subsequent intraocular or refractive surgery in the operative eye, and 5-year Snellen visual acuity of 20/60 or worse. Outcomes of interest were change in spherical equivalent (SE) and change in magnitude of the astigmatism vector between the postoperative month 1 and postoperative year 5 refractions. Refractive stability was defined as ≤0.5 diopter (D) change in SE and ≤1 D change in magnitude of the astigmatism vector. Predictive factors analyzed included age, sex, race, pseudoexfoliation (PXF) syndrome, axial length (AL), preoperative keratometry measurements (∆K), IOL power, neodymium:yttrium aluminum garnet capsulotomy, and intravitreal injections.

Results: Of the 320 eyes meeting study criteria, SE was stable in 241 (75%) eyes, astigmatism was stable in 266 (83%) eyes, and 205 (64%) eyes met criteria for refractive stability with both measures. Multivariable regression analysis identified shorter AL ( P = .018) and larger ∆K ( P = .002) as significant predictors of change in refractive astigmatism and PXF syndrome ( P = .006) as a predictor of hyperopic shift >0.5 D.

Conclusions: A minority of eyes exhibit late refractive change after TIOL implantation. AL, ∆K, and PXF syndrome are independent predictors of late refractive change.