End the Bad Luck: Strategies for Refractive Surprise (Presentation and Discussion)

簡克鴻 Ke-Hung ChienTaiwan Speaker End the Bad Luck: Strategies for Refractive SurpriseDr. Chien will discuss the phenomenon of refraction surprise following cataract surgery—a postoperative outcome in which the patient’s refractive result differs from the intended target. Despite significant advancements in biometry technology, intraocular lens (IOL) power calculation formulas, and surgical techniques, refractive unpredictability can still occur and remains a noteworthy challenge in contemporary cataract surgery. A variety of factors may contribute to refraction surprise, including inaccurate axial length measurement, corneal surface irregularities, posterior corneal astigmatism, unrecognized IOL tilt or decentration, and intraoperative issues such as capsular instability. Additionally, postoperative anatomical changes may further alter refractive outcomes. Recognizing risk factors early and ensuring meticulous preoperative assessment are essential. When refraction surprise does occur, management options depend on both the underlying etiology and the magnitude of refractive deviation. Strategies include corneal refractive enhancement, piggyback IOL implantation, IOL exchange, or non-surgical approaches such as updating spectacles or contact lenses. Through case discussions and surgical experience sharing, Dr. Chien will present practical methods for preventing, diagnosing, and managing this complication—ultimately enhancing patient satisfaction and improving visual outcomes.