Refractive factors affecting uncorrected visualacuity in postoperative cataract surgery

The objective of this study is to evaluate the refractive factors influencing postoperative visual outcomes in patients who underwent phacoemulsification surgery for uncomplicated age-related cataracts. This retrospective study included 90 eyes from 90 patients who underwent phacoemulsification surgery exclusively for uncomplicated age-related cataracts. Only one eye per patient was analyzed. Best-corrected visual acuity and refractive changes were meticulously assessed during postoperative follow-ups. Inclusion criteria comprised undergoing phacoemulsification surgery, achieving a postoperative best-corrected visual acuity of 1.0, and having no additional ocular pathologies. Only patients without surgery- related complications were included. Cases with intraoperative or postoperative complications were excluded from the study. Additionally, individuals with a history of amblyopia, macular pathologies, or corneal diseases that could compromise visual acuity were not considered in the analysis. All data were retrospectively obtained from patient records and biometry reports. The collected data were subjected to statistical analysis to identify their associations with surgical outcomes. No significant difference was observed in postoperative visual acuity between the right and left eyes of the patients, nor between male and female patients. During postoperative follow-ups, significant differences were detected in near visual acuity between with-the-rule and against-the-rule astigmatism, whereas no significant difference was found in distance visual acuity. A positive correlation was identified between uncorrected distance visual acuity and both the radius of curvature in the steepest corneal meridian and the anterior corneal surface cylindrical refractive values. Conversely, a negative correlation was observed between uncorrected distance visual acuity and the cylindrical refractive values of total astigmatism and keratometric astigmatism. A positive correlation was found between uncorrected near visual acuity and the pupil center as well as spherical refractive values. In contrast, negative correlations were observed with the radius of curvature in the flattest meridian, the radius of curvature in the steepest meridian, the average corneal radius of curvature, the maximum curvature at the steepest corneal point, cylindrical refractive values, and total astigmatism cylindrical refractive values. According to multiple linear regression analysis, the corneal parameters that had a statistically significant impact on uncorrected distance visual acuity were identified as keratometric astigmatism cylindrical refractive value, anterior corneal surface astigmatism cylindrical refractive value, and posterior corneal surface astigmatism cylindrical refractive value. In the stepwise total model of multiple linear regression, these significant corneal parameters were included in a correlation analysis with uncorrected distance and near visual 57 acuity. A statistically significant positive correlation was found between uncorrected distance visual acuity and keratometric astigmatism cylindrical refractive value, whereas no statistically significant correlation was observed with posterior corneal surface astigmatism cylindrical refractive value. Conversely, a negative correlation was identified between uncorrected distance visual acuity and anterior corneal surface astigmatism cylindrical refractive value. Multiple linear regression analysis revealed that the only corneal parameter with a statistically significant effect on uncorrected near visual acuity was the spherical refractive value. Correlation analysis confirmed a statistically significant positive correlation between spherical refractive value and uncorrected near visual acuity. The findings of this study reveal the effects of corneal biometric parameters and refractive factors on visual acuity after cataract surgery. The results provide guidance for improving postoperative visual outcomes.