Cataract surgery outcomes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery

J Cataract Refract Surg. 2015 Nov;41(11):2358-65. doi: 10.1016/j.jcrs.2015.04.034.


Purpose: To analyze visual outcomes after cataract surgery in patients with previous corneal refractive surgery.

Setting: Cataract surgery clinics in 18 European countries and Australia.

Design: Database study.

Methods: Cases of cataract extraction with corneal refractive surgery eyes (corneal refractive cases) were identified from all cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery database over a 5-year period. Preoperative and postoperative measurements and trends over time were analyzed.

Results: Of 807,220 cataract extractions, 1229 (0.15%) were corneal refractive cases. There was a significant increase, over time, in the number of corneal refractive cases (P < .001). Corneal refractive patients were younger than patients without corneal refractive surgery (nonrefractive patients) (62.9 years versus 74.0 years; P < .001) but had similar mean preoperative and postoperative corrected-distance visual acuity (CDVA) (preoperative logMAR 0.44[6/16] for both [P = .286]; postoperative logMAR 0.06[6/7] for both [P = .245]). Postoperative CDVA was worse than preoperative CDVA in 35 (4%) corneal refractive and 8,999 (1.5%) nonrefractive patients (P < .001). In all, 74 (8.5%) of 873 corneal refractive versus 16,566 (2.8%) /584,496 nonrefractive patients, having cataract surgery, had preoperative CDVA of logMAR 0.0[6/6] or better (P < .001). Nineteen (54.3%) of 35 corneal refractive case patients who had worse postoperative CDVA had preoperative CDVA of logMAR 0.0(6/6) or better.

Conclusion: Cataract surgery has been reported with increasing frequency in corneal refractive surgery patients, since 2008. These patients had preoperative CDVA similar to those of patients without previous corneal refractive surgery but were younger and were at higher risk of worse postoperative CDVA, especially if they had preoperative CDVA of logMAR 0.0(6/6) or better.

Financial disclosure: No author has any financial or proprietary interest in any material, or method, mentioned.

MeSH terms

  • Aged
  • Cataract Extraction / standards
  • Cataract Extraction / statistics & numerical data*
  • Corneal Diseases / surgery
  • Databases, Factual
  • European Union
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Quality of Health Care / standards*
  • Refractive Surgical Procedures / standards
  • Refractive Surgical Procedures / statistics & numerical data*
  • Registries*
  • Visual Acuity