Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery

Purpose: To analyze risk factors for refractive error after cataract surgery and provide a benchmark for refractive outcomes after standard cataract surgery. setting: One hundred cataract surgery clinics from 12 European countries. Design: Multicenter database study. Methods: Data on consecutive cataract extractions reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery between January 1, 2014 and December 31, 2015 were analyzed in terms of demographics, preoperative corrected distance visual acuity (CDVA), target refraction, coexisting eye diseases, surgical difficulties including previous ophthalmic interventions, type of surgery, intraocular lens (IOL), and surgical complications. For clinics committed to reporting follow-up data within 7 to 60 days after surgery, postoperative CDVA and refraction were analyzed. Results: Of the 548 392 cases analyzed, follow-up data were available for 282 811 cases. The absolute mean biometry prediction error in spherical equivalent was 0.42 diopters (D). A biometry prediction error within +/- 0.50 D was achieved for 205 675 eyes (72.7%). A biometry prediction error within +/- 1.0 D was achieved for 263 015 eyes (93.0%). Poor preoperative CDVA, target refraction, coexisting eye diseases, surgical difficulties including previous ophthalmic interventions, and surgical complications were in varying degrees related to a postoperative refractive error. Conclusions: Several risk factors (poor preoperative CDVA, ocular comorbidity, and previous eye surgery) were related to poor refractive outcomes after cataract extraction. When these risk factors are present, care should be taken with the preoperative examination and choice of IOL to avoid a refractive surprise. The average outcomes can be used as a refractive outcome benchmark.