Cataract Surgery

  • Melanie Corbett
  • Nicholas Maycock
  • Emanuel Rosen
  • David O’Brart


Modern cataract surgery aims not only to remove the cataract but to reduce the patient’s dependence upon spectacles postoperatively. In the eyes with regular corneas, this is best achieved using the keratometry measurements within the biometry device to calculate the strength of intraocular lens to use. However, in irregular corneas and following refractive surgery, the preoperative topography is valuable for selecting the most appropriate keratometry values to use in the nomograms and planning the incision.

Postoperatively, topography can be useful to investigate less desirable outcomes. It may identify peripheral corneal flattening associated with the incision or irregularity if sutures were used. It can confirm the corneal curvature in cases of refractive surprise.


Corneal topography Cataract surgery Extracapsular Phacoemulsification Keratometry Biometry Astigmatism Incision Corneal sutures Tight sutures Loose sutures Refractive surprise 


* References Particularly Worth Reading

  1. 1.
    *Swinger CA. Postoperative astigmatism. Surv Ophthalmol. 1987;31:219–48.CrossRefGoogle Scholar
  2. 2.
    *van Rij G, Waring GO III. Changes in corneal curvature induced by sutures and incisions. Am J Ophthalmol. 1984;98:773–83.CrossRefGoogle Scholar
  3. 3.
    Donders F. On the anomalies of refraction and accommodation of the eye. London: The New Sydenham Society; 1864.Google Scholar
  4. 4.
    von ReussWoinow. Ophthalmometrische Studien. Wein; 1869.Google Scholar
  5. 5.
    *Nordan LT, Lusby FW. Refractive aspects of cataract surgery. Curr Opin Ophthalmol. 1995;6:36–40.Google Scholar
  6. 6.
    *Minkovitz JB, Stark WJ. Corneal complications of intraocular surgery. Curr Opin Ophthalmol. 1995;6:79–85.CrossRefGoogle Scholar
  7. 7.
    *Martinez CE, Klyce SD. Corneal topography in cataract surgery. Curr Opin Ophthalmol. 1996;7:31–8.CrossRefGoogle Scholar
  8. 8.
    Thornton SP. Clinical evaluation of corneal topography. J Cataract Refract Surg. 1993;19(Suppl):198–202.CrossRefGoogle Scholar
  9. 9.
    Sanders DR, Retzlaff J, Kraff MC. Comparison of the SRK II″ formula and other second generation formulas. J Cataract Refract Surg. 1988;14:136–41.CrossRefGoogle Scholar
  10. 10.
    Holladay JT. Standardizing constants for ultrasonic biometry, keratometry, and intraocular lens power calculations. J Cataract Refract Surg. 1997;23(9):1356–70.CrossRefGoogle Scholar
  11. 11.
    Haigis VV. The Haigis formula. Chap 5. In: Shammas H, editor. Intraocular lens power calculations. Thorofare: Slack; 2003. p. 41–57.Google Scholar
  12. 12.
    Hoffer KJ. The Hoffer Q formula: a comparison of theoretic and regression formulas. J Cataract Refract Surg. 1993;19:700–12.CrossRefGoogle Scholar
  13. 13.
    Melles RB, Holladay JT, Chang WJ. Accuracy of intraocular lens calculation formulas. Ophthalmology. 2018;125(2):169–78.CrossRefGoogle Scholar
  14. 14.
    Koch DD, Hill W, Albulafia A, et al. Pursuing perfection in intraocular lens calculations: I. Logical approach for classifying IOL calculation formulas. JCRS. 2017;43(6):717–8.Google Scholar
  15. 15.
    Barrett GD. Barrett universal II formula. Singapore: Asia-Pacific Association of Cataract and Refractive Surgeons. Available at: Accessed 5 Jul 2016.
  16. 16.
    Ascaso FJ, Castillo JM, Cristobal JA, Minguez E, Palomar A. A comparative study of eight intraocular lens calculation formulas. Ophthalmologica. 1991;203:148–53.CrossRefGoogle Scholar
  17. 17.
    Barrett GD. An improved universal theoretical formula for intraocular lens power prediction. J Cataract Refract Surg. 1993;19:713–20.CrossRefGoogle Scholar
  18. 18.
    Hoffer KJ. The Hoffer Q formula: comparison of theoretic and regression formulas. J Cataract Refract Surg. 1993;19:700–12.CrossRefGoogle Scholar
  19. 19.
    *Cuaycong MJ, Gay CA, Emery J, Haft EA, Koch DD. Comparison of the accuracy of computerized videokeratoscopy and keratometry for use in intraocular lens calculations. J Cataract Refract Surg. 1993;19(Suppl):178–81.CrossRefGoogle Scholar
  20. 20.
    Husain SE, Kohnen T, Maturi R, Er H, Koch DD. Computerised videokeratography and keratometry in determining intraocular lens calculations. J Cataract Refract Surg. 1996;22:362–6.CrossRefGoogle Scholar
  21. 21.
    Hovding G, Natvik C, Sletteberg O. The refractive error after implantation of a posterior chamber intraocular lens. The accuracy of IOL power calculation in a hospital practice. Acta Ophthalmol. 1994;72:612–6.CrossRefGoogle Scholar
  22. 22.
    *Koch DD, Haft EA, Gay C. Computerized videokeratographic analysis of corneal topographic changes induced by sutured and unsutured 4mm scleral pocket incisions. J Cataract Refract Surg. 1993;19(Suppl):166–9.CrossRefGoogle Scholar
  23. 23.
    McDonnell PJ. Can we avoid an epidemic of refractive ‘surprises’ after cataract surgery? [editorial]. Arch Ophthalmol. 1997;115:542–3.CrossRefGoogle Scholar
  24. 24.
    Celikkol L, Ahn D, Celikkol G, Feldman ST. Calculating intraocular lens power in eyes with keratoconus using videokeratography. J Cataract Refract Surg. 1996;22:497–500.CrossRefGoogle Scholar
  25. 25.
    Serdarevic ON, Renard GJ, Pouliquen Y. Videokeratoscopy of recipient peripheral corneas in combined penetrating keratoplasty, cataract extraction, and lens implantation. Am J Ophthalmol. 1996;122:29–37.CrossRefGoogle Scholar
  26. 26.
    Flowers CW, MdLeod SD, McDonnell PJ, Irvine JA, Smith RE. Evaluation of intraocular lens power calculation formulas in the triple procedure. J Cataract Refract Surg. 1996;22:116–22.CrossRefGoogle Scholar
  27. 27.
    Koch DD, Liu JF, Hyde LL, Rock RL, Emery JM. Refractive complications of cataract surgery after radial keratotomy. Am J Ophthalmol. 1989;108:676–82.CrossRefGoogle Scholar
  28. 28.
    *Hoffer KJ. Intraocular lens power calculation for eyes after refractive keratotomy. J Refract Surg. 1995;11:490–3.Google Scholar
  29. 29.
    Lyle WA, Jin GJC. Intraocular lens power prediction in patients who undergo cataract surgery following previous radial keratotomy. Arch Ophthalmol. 1997;115:457–61.CrossRefGoogle Scholar
  30. 30.
    Lesher MP, Schumer DJ, Hunkeler JD, Durrie DS, McKee FE. Phacoemulsification with intraocular lens implantation after excimer photorefractive keratectomy: a case report. J Cataract Refract Surg. 1994;20(Suppl):265–7.CrossRefGoogle Scholar
  31. 31.
    Siganos DS, Pallikaris IG, Lambropoulos JE, Koufala CJ. Keratometric readings after photorefractive keratectomy are unreliable for calculating IOL power. J Refract Surg. 1996;12:S278–9.PubMedGoogle Scholar
  32. 32.
    Kalski RS, Danjoux J-P, Fraenkel GE, Lawless MA, Rogers C. Intraocular lens power calculation for cataract surgery after photorefractive keratectomy for high myopia. J Refract Surg. 1997;13:362–6.PubMedGoogle Scholar
  33. 33.
    Sanders RD, Gills JP, Martin RG. When keratometric measurements do not accurately reflect corneal topography. J Cataract Refract Surg. 1993;19(Suppl):131–5.CrossRefGoogle Scholar
  34. 34.
    Vass C, Menapace R. Computerised statistical analysis of corneal topography for the evaluation of changes in corneal shape after surgery. Am J Ophthalmol. 1994;118:177–84.CrossRefGoogle Scholar
  35. 35.
    Holladay JT, Cravy TV, Koch DD. Calculation of surgically induced refractive change following ocular surgery. J Cataract Refract Surg. 1992;18:429–43.CrossRefGoogle Scholar
  36. 36.
    *Kohnen T, Koch DD. Control of astigmatism in cataract surgery. Curr Opin Ophthalmol. 1996;7:75–80.Google Scholar
  37. 37.
    Hall GW, Campion M, Sorenson CM, Monthofer S. Reduction of corneal astigmatism at cataract surgery. J Cataract Refract Surg. 1991;17:407–14.CrossRefGoogle Scholar
  38. 38.
    Kershner RM. Keratolenticuloplasty: arcuate keratotomy for cataract surgery and astigmatism. J Cataract Refract Surg. 1995;21(and comments in J Cat Refract Surg 1995; 21: 597-8):274–7.CrossRefGoogle Scholar
  39. 39.
    Masket S. Arcuate keratotomy for cataract surgery and astigmatism [letter]. J Cataract Refract Surg. 1995;21:597–8.CrossRefGoogle Scholar
  40. 40.
    *Nielsen PJ. Prospective evaluation of surgically induced astigmatism and astigmatic keratotomy effects of various self-sealing small incisions. J Cataract Refract Surg. 1995;21:43–8.CrossRefGoogle Scholar
  41. 41.
    Kohnen T. Corneal shape changes and astigmatic aspects of scleral and corneal tunnel incisions [editorial]. J Cataract Refract Surg. 1997;23:301–2.CrossRefGoogle Scholar
  42. 42.
    Girard LJ, Rodriguez J, Mailman ML. Reducing surgically induced astigmatism by using a scleral tunnel. Am J Ophthalmol. 1984;97:450–6.CrossRefGoogle Scholar
  43. 43.
    Hayashi K, Nakao F, Hayashi F. Corneal topographic analysis of superolateral incision cataract surgery. J Cataract Refract Surg. 1994;20:392–9.CrossRefGoogle Scholar
  44. 44.
    *Martin RG, Sanders DR, Miller JD, Cox CC, Ballew C. Effect of cataract wound incision size on acute changes in corneal topography. J Cataract Refract Surg. 1993;19(Suppl):170–7.CrossRefGoogle Scholar
  45. 45.
    Levy JH, Pisacano AM, Chadwick K. Astigmatic changes after cataract surgery with 5.1mm and 3.5mm sutureless incisions. J Cataract Refract Surg. 1994;20:630–3.CrossRefGoogle Scholar
  46. 46.
    Oshika T, Tsuboi S, Yaguchi S, Yoshitomi F, Nagamoto T, Nagahara K, Emi K. Comparative study of intraocular lens implantation through 3.2 and 5.5mm incisions. Ophthalmology. 1994;101:1183–90.CrossRefGoogle Scholar
  47. 47.
    Feil SH, Crandall AS, Olson RJ. Astigmatic decay following small incision, self-sealing cataract surgery. J Cataract Refract Surg. 1994;20:40–3.CrossRefGoogle Scholar
  48. 48.
    *Hayashi K, Hayashi H, Nakao F, Hayashi F. The correlation between incision size and corneal shape changes in sutureless cataract surgery. Ophthalmology. 1995;102:550–6.CrossRefGoogle Scholar
  49. 49.
    Kohnen T, Dick B, Jacobi KW. Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes. J Cataract Refract Surg. 1995;21:417–24.CrossRefGoogle Scholar
  50. 50.
    Long DA, Monica ML. A prospective evaluation of corneal curvature changes with 3.0- to 3.5-mm corneal tunnel phacoemulsification. Ophthalmology. 1996;103:226–32.CrossRefGoogle Scholar
  51. 51.
    Pfleger T, Skorpik C, Menapace R, Scholz U, Weghaupt H, Zehetmayer M. Long-term course of induced astigmatism after clear corneal incision cataract surgery. J Cataract Refract Surg. 1996;22:72–7.CrossRefGoogle Scholar
  52. 52.
    Ernest PH. Corneal lip tunnel incision. J Cataract Refract Surg. 1994;20:154–7.CrossRefGoogle Scholar
  53. 53.
    Vass C, Menapace R, Rainer G. Corneal topographic changes after frown and straight sclerocorneal incisions. J Cataract Refract Surg. 1997;23:913–22.CrossRefGoogle Scholar
  54. 54.
    Vass C, Menapace R, Amon M, Hirsch U, Yousef A. Batch-by-batch analysis of topographic changes induced by sutured and sutureless clear corneal incisions. J Cataract Refract Surg. 1996;22:324–30.CrossRefGoogle Scholar
  55. 55.
    Eve FR, Troutman RC. Placement of sutures used in corneal incisions. Am J Ophthalmol. 1976;82:786–9.CrossRefGoogle Scholar
  56. 56.
    Wishart MS, Wishart PK, Gregor ZJ. Corneal astigmatism following cataract extraction. Br J Ophthalmol. 1986;70:825–30.CrossRefGoogle Scholar
  57. 57.
    O’Driscoll AM, Goble RR, Hallack GN, Andrew NC. A prospective, controlled study of a 9/0 elastic polypropylene suture for cataract surgery: refractive results and complications. Eye. 1994;8:538–42.CrossRefGoogle Scholar
  58. 58.
    Drews RC. Astigmatism after cataract surgery: nylon versus mersilene. J Cataract Refract Surg. 1995;21:70–2.CrossRefGoogle Scholar
  59. 59.
    Potamitis T, Fouladi M, Eperjese F, McDonnell PJ. Astigmatism decay immediately following suture removal. Eye. 1997;11:84–6.CrossRefGoogle Scholar
  60. 60.
    Olsen T, Dam-Johansen M, Beke T, Hjortdal JO. Evaluating surgically induced astigmatism by Fourier analysis of corneal topography data. J Cataract Refract Surg. 1996;22:318–23.CrossRefGoogle Scholar
  61. 61.
    Luntz MH, Livingstone DG. Astigmatism in cataract surgery. Br J Ophthalmol. 1977;61:360–5.CrossRefGoogle Scholar
  62. 62.
    Kronish JW, Forster RK. Control of corneal astigmatism following cataract extraction by selective suture cutting. Arch Ophthalmol. 1987;105:1650–5.CrossRefGoogle Scholar
  63. 63.
    Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol. 1982;66:556–9.CrossRefGoogle Scholar
  64. 64.
    Atkins AD, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol. 1985;69:348–51.CrossRefGoogle Scholar
  65. 63.
    Lakshminarayanan V, Enoch JM, Raasch T, Crawford B, Nydaard RW. Refractive changes induced by intraocular lens tilt and longitudinal displacement. Arch Ophthalmol. 1986;104:90–2.CrossRefGoogle Scholar
  66. 64.
    Güell JL, Manero F, Müller A. Transverse keratotomy to correct high corneal astigmatism after cataract surgery. J Cataract Refract Surg. 1996;22:331–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Melanie Corbett
    • 1
  • Nicholas Maycock
    • 2
  • Emanuel Rosen
    • 3
  • David O’Brart
    • 4
  1. 1.Imperial College Healthcare NHS TrustLondonUK
  2. 2.University Hospital Coventry and WarwickshireCoventryUK
  3. 3.ManchesterUK
  4. 4.Department of OphthalmologySt. Thomas HospitalLondonUK

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