An Abnormal Increase in Corneal Astigmatism after Cataract Surgery in a Post-LASIK Eye: A Case Report

An Abnormal Increase in Corneal Astigmatism after Cataract Surgery in a Post-LASIK Eye: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report An Abnormal Increase in Corneal Astigmatism after Cataract Surgery in a Post-LASIK Eye: A Case Report chenxi Li, Fan Yang, Peimin Lin, zihan Xie, Shiyu Tang, jie Xu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8356913/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: To investigate the impact of prior corneal refractive surgery on visual quality after phacoemulsification with toric intraocular lens (toric IOL) implantation. Case presentation: We report the case of a 55-year-old male with a history of bilateral LASIK who underwent phacoemulsification with toric IOL implantation for cataracts and astigmatism in the right eye, with a focus on the diagnosis and management of intraocular lens rotation and astigmatism fluctuations postoperatively. Results: The patient exhibited an abnormal increase in preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs) after cataract surgery and toric IOL implantation due to lens rotation, requiring IOL repositioning. Postoperative corneal astigmatism showed an abnormal increase of 1.75 D but gradually stabilized after an extended recovery period. Conclusions: A history of refractive surgery significantly affects postoperative corneal astigmatism during cataract surgery, increasing prediction errors and prolonging postoperative recovery in toric IOL patients. Cautious patient selection and thorough preoperative consultation are essential. Corneal astigmatism Cataract surgery Preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs) LASIK surgery Toric intraocular lens Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Cataracts remain one of the leading causes of blindness worldwide [ 1 , 2 ] . Epidemiological data indicate that the prevalence of and blindness rates associated with cataracts have significantly increased due to population aging, with a 30% increase in cataract-induced blindness from 20002020 [ 3 ] . Over 40% of cataract patients present astigmatism of ≥ 1.00 diopters (D), which, if left untreated, substantially impairs visual acuity [ 4 ] . With advancements in technology and research, astigmatism can now be predicted and corrected using toric IOLs [ 4 , 5 ] . Toric IOLs are capable of correcting astigmatism ≥ 1.50 D [ 6 , 7 ] and are currently widely used among cataract patients with corneal astigmatism. A measurable discrepancy in corneal astigmatism before and after surgery is expected with standard cataract procedures. We used vector analysis to evaluate the preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs). Typically, the observed differences in corneal astigmatism before and after cataract surgery result primarily from surgical incisions that induce differential changes in refractive power along various meridians and lead to changes in corneal astigmatism, which is formally termed surgically induced astigmatism (SIA). Studies have reported that the average SIA after microincision cataract surgery is 0.57 ± 0.33 D at 1 week postoperatively, decreasing to 0.36 ± 0.25 D by 3 months [ 8 ] . Under normal ocular conditions, the effect of SIA is typically minimal and tolerable. Research suggests that SIA peaks in the early postoperative period (1–3 weeks), decreases significantly within 3 months, and then stabilizes after 1 year [ 8 ] . The global prevalence of myopia is increasing due to lifestyle changes [ 9 ] , leading to an increasing demand for refractive surgeries, particularly among young individuals. Over the past 25 years, an estimated 20–25 million laser vision correction surgeries have been performed, with LASIK accounting for 80–85% of patients [ 10 ] . First successfully applied in humans in 1991 [ 11 ] , LASIK has experienced rapid development and market expansion. However, the earliest cohort of LASIK patients now faces age-related cataracts after 35 years. These individuals often have greater visual demands and stronger motivations for spectacle independence. However, corneal morphological changes induced by refractive surgery, such as corneal ectasia (progressive forward displacement and central steepening and thinning) and defentered ablations [ 12 ] , may lead to more complicated postoperative recovery after subsequent cataract surgery. Current studies on post-LASIK patients undergoing cataract surgery have primarily evaluated short-term astigmatic outcomes but lack follow-up data extending beyond one year. For example, some studies have suggested that, in post-LASIK eyes, SIA was greater and that recovery was slower during the early postoperative period (1–3 months) than in controls; however, this significant difference diminished by 6 months [ 13 ] . Other studies have reported greater SIA in post-LASIK eyes but lack longitudinal data on its temporal evolution [ 14 ] . This study presents the first documented case of abnormally exacerbated corneal astigmatism (vector change: +1.75 D) in a post-LASIK patient after cataract surgery, highlighting the complexity of postoperative recovery in this population. Additionally, this report provides extended follow-up data (10 months), confirming that astigmatism fluctuations may be alleviated over time, with a 42% decrease from 2 to 10 months postoperatively. Moreover, this is the first case combining a history involving LASIK, cataract surgery, and toric IOL repositioning. Importantly, we emphasize the importance of stability assessment in patients with prior refractive surgery, providing an evidence-based reference for preoperative counseling (noting an estimated 30% probability of reoperation) and surgical planning (such as the selection of toric IOLs combined with capsular tension rings). Case Report (1) Case Presentation The patient was a 54-year-old male administrative staff member who presented with a two-year history of unexplained progressive vision decline and blurred vision in his right eye. He requested complete spectacle independence for both distance and near vision with simultaneous astigmatism correction. Preoperative examination revealed an uncorrected distance visual acuity of 0.3 in both eyes, with near visual acuity of J4 in the right eye and J3 in the left eye. The right eye showed no improvement with spectacle correction, whereas the left eye was correctable at 0.6. Both eyes presented normal intraocular pressure. Physical examinations revealed transparent corneas in both eyes without aqueous flare (FL(-)) or keratic precipitates (KP(-)) and a normal anterior chamber depth. The right eye presented with nuclear cataracts classified as C2N4P2 (moderate nuclear sclerosis) (Table 1). B-scan ultrasound and fundoscopic examination revealed no contraindications for cataract surgery, with normal corneal endothelial cell counts in both eyes (Figures 1 and 2). The final diagnosis was complicated cataract in the right eye. The patient underwent bilateral LASIK surgery for high myopia ten years prior, with good postoperative visual acuity, and remained in a low myopic state before cataract surgery. Ocular measurement parameters revealed that the patient's axial length (AL=29.81 mm) and anterior chamber depth (ACD=3.57 mm) in both eyes were significantly greater than normal adult averages, indicating a high myopic ocular structure and axial myopia. As shown in the table below, the IOL Master 700 measured the right eye corneal astigmatism values as follows: K-value astigmatism: 0.70 D @ 63°, TK-value astigmatism: 0.67 D @ 52°; the Pentacam measured the corneal astigmatism at 3 mm in the right eye; SimK-value astigmatism: 1.6 D @ 66.0°, TCRP-value astigmatism: 1.7 D @ 62.6°, TNP-value astigmatism: 1.7 D @ 62.3°, and ERK-value astigmatism: 1.53 D @ 61.6° (Table 2). The astigmatism was relatively high with a somewhat irregular symmetrical form. There was also a significant difference in astigmatism measurements between the two devices, reflecting the complexity of the patient's corneal morphology. (2) Two surgical procedures Based on preoperative examinations and the patient's strong desire for spectacle independence, the first surgery, comprising phacoemulsification with intraocular lens implantation and capsular tension ring insertion, was performed on January 16, 2024. The intended toric IOL was model 909, with a planned axis alignment at 50 degrees. The ZEISS 909 IOL is a bifocal toric IOL with a spherical power of +17 D and a cylindrical power of +1.0 D. The target postoperative refractive state was -0.09 D spherical and +0.14 D cylindrical. The surgical approach included a 2.3 mm clear corneal incision at the 145° position, with viscoelastic injection into the anterior chamber and a 1 mm side incision at the 90-degree position. Continuous curvilinear capsulorhexis was performed with a diameter of approximately 5.3 mm. On the first postoperative day, the visual acuity was 0.3, with mild corneal edema. By the eighth day, the corneal edema had resolved, but uncorrected visual acuity remained at 0.3, with a best-corrected visual acuity value of 0.5 and 2.50 D of astigmatism. Pupillary dilation revealed significant IOL rotation, with the IOL axis shifting from the intended 50-degree angle to a 10-degree angle. Studies have shown that approximately 1 degree of toric IOL misalignment reduces astigmatic correction by 3.3%, and a 30 -degree misalignment not only fails to correct astigmatism but may also exacerbate it [15, 16] . After thorough discussions with the patient, an IOL repositioning surgery was performed on January 24, 2024 (2 weeks postoperatively). Postoperative assessment verified optimal IOL alignment at the intended 50-degree axis (Figure 3, the comparison before and after repositioning). (3) Postoperative follow-up The patient underwent multiple follow-up examinations, with the longest follow-up period extending to 10 months. The examination instruments used primarily included an IOL Master 700 and a Pentacam, which measure six corneal astigmatism parameters: keratometry astigmatism (K), total keratometry astigmatism (TK), simulated keratometry astigmatism (SimK), true corneal refractive power astigmatism (TCRP), total net power astigmatism (TNP), and equivalent keratometry astigmatism (ERK). One month after the operation (0.5 months following repositioning), the patient's uncorrected visual acuity was 0.4, which was correctable to 0.8+ and had a refractive error of -1.75/-1.50 × 180°. Pupillary dilation confirmed the IOL axis at 50°, and Pentacam showed increased corneal astigmatism (SimK 2.1 D, TCRP 2.3 D) compared with the preoperative values. At 2 months post-surgery, uncorrected visual acuity improved to 0.7, with a best-corrected visual acuity of 0.8+ and a refraction error of -1.50/-1.50 × 170. Pentacam demonstrated further increases in corneal astigmatism (SimK 2.3 D, TCRP 2.6 D), and IOL Master measurements also revealed significant increases in corneal astigmatism (K: 1.92 D, TK: 2.25 D) compared with the preoperative values. By 3 months post-surgery, uncorrected visual acuity stabilized at 0.7, with a best-corrected visual acuity of 0.8 and a refraction of -1.75/-1.00 × 165. Compared with those at 2 months, the corneal astigmatism values slightly improved but remained higher than the preoperative values. At the final 10-month follow-up, uncorrected visual acuity remained at 0.7, with a best-corrected visual acuity of 0.7 and a refraction of -1.50/-1.00 × 175. Pentacam resulted in further reductions in corneal astigmatism values (Table 3). A review of the patients’ follow-up records revealed significant fluctuations in astigmatism. In addition to scalar measurements, to account for the vector characteristics of astigmatism, we employed the Alpin vector analysis method to calculate the PCAV for multiple corneal astigmatic parameters. The resulting fluctuation graphs for both corneal astigmatism and PCAV are illustrated in Figure 4. The maximum degree of corneal astigmatism occurred at 2 months (TNP peaked at 2.5 D), with a notable increase from 1 to 2 months. ERK showed the most pronounced change—an increase of 0.34 D (a 15.1% increase). Astigmatism decreased significantly from 2 to 3 months and from 3 to 10 months, with ERK showing the most pronounced change—a decrease of 0.8 D (a reduction of 30.9%). The maximum PCAV occurred at 2 months (TK peaked at 1.68 D), with a notable increase from 1 to 2 months. ERK showed the most pronounced change—an increase of 0.42 D (a 56.1% increase). The PCAV decreased significantly from 2 to 3 months (ERK decreased the most (by 0.8 D, a reduction of 68.9%)). From 3 to 10 months, some PCAV parameters decreased (TK decreased by 0.46 D), whereas others increased (TNP increased by 0.3 D), with all changes being significant. Overall, the PCAV began to stabilize after 10 months. Therefore, in this post-LASIK patient, corneal astigmatism and PCAV required a minimum 10-month stabilization period following cataract surgery. Both the magnitude and the stabilization time were greater than those in normal post-cataract surgery patients. Analysis of preoperative and postoperative Pentacam reports (Figure 5) revealed a relatively flat central corneal curvature, reflecting a previous history of LASIK surgery. The follow-up Pentacam consistently highlighted a regular and symmetrical "bow-tie" pattern in the central cornea, with multiple Pentacams indicating with-the-rule astigmatism. Changes in astigmatism axis positioning, central corneal thickness, central corneal curvature, and total refractive power were analyzed (see Figure 6). We observed maximal surgical impact on the morphology of the incision site cornea at 2 months after surgery, with a progressive decrease thereafter. Concurrently, the global cornea also tended to flatten with the recovery of the localized incision site. Central corneal thickness and the astigmatism axis followed trends similar to those of the degree of astigmatism, peaking at 2 months postoperatively. In contrast, central corneal curvature and total corneal refractive power peaked earlier, at 1 month postoperatively. Discussion This case involved a 55-year-old male who underwent bilateral LASIK surgery 10 years prior and subsequently developed progressive vision loss in his right eye over two years. He underwent phacoemulsification with toric intraocular lens (IOL) implantation, followed by postoperative IOL rotation exceeding 30° and persistent astigmatic fluctuations. After repositioning surgery, both the degree of corneal astigmatism and the PCAV gradually stabilized. In this case, the patient experienced IOL rotation, which emerged as a significant complication in toric IOL implantation [ 17 , 18 ] . As a high myopia patient, this patient exhibited a larger capsular bag, while the elongated axial length subjected the zonules to additional mechanical stress, leading to zonular laxity and an increased risk of IOL rotation. The optimal window for toric IOL repositioning is typically 1 to 15 days postoperatively [ 18 , 19 ] . In this case, prompt repositioning surgery ensured timely correction of the misaligned toric IOL. The abnormally elevated and prolonged fluctuations in postoperative corneal astigmatism may be attributed to multiple factors. Although the second surgery did not alter the incision size or configuration, it may have delayed wound healing, potentially impacting corneal and intraocular structural stability and thereby influencing postoperative corneal astigmatism [ 20 ] . Additionally, a history of refractive surgery can lead to irreversible corneal changes, including reduced biomechanical strength and iatrogenic corneal ectasia (corneal thinning, protrusion, and irregular astigmatism) [ 12 , 21 , 22 ] , which may contribute to exaggerated postoperative corneal astigmatism. This case illustrates how preexisting corneal biomechanical alterations from refractive surgery resulted in an atypical response to surgical incisions. The incision site biomechanical modifications propagated through corneal stress redistribution, ultimately inducing global corneal abnormalities. In addition, the cumulative effect of three ocular surgeries (LASIK, cataract extraction, and IOL repositioning) may have further compromised corneal biomechanical stability, increasing the risk of postoperative astigmatic fluctuations. In addition to the astigmatic changes induced by surgical incisions, the abnormal increase in corneal astigmatism in this case may involve more complex contributing factors. A prior report indicated delayed corneal ectasia six years after LASIK, progressing to acute corneal edema [ 23 ] , suggesting that subtle interstitial corneal edema may exist under the LASIK flap and influence corneal astigmatism in this case. Analysis of corneal thickness changes revealed a parallel trend with astigmatism, peaking at 20 days postoperatively before gradually stabilizing, confirming that LASIK cataract surgery indeed alters corneal thickness and impacts astigmatism. Moreover, calculation formula-derived errors may also contribute to the abnormal increase in postoperative corneal astigmatism. Although the Barrett True-K formula reduces the MAE to 0.5–0.7 D (vs. 0.7–1.2 D with conventional formulas), its accuracy remains suboptimal in post-LASIK eyes, with only 65% within ± 0.5 D versus virgin eyes [ 24 , 25 ] . Finally, LASIK-induced central corneal flattening may introduce measurement errors in keratometry, as the IOL Master evaluates the paracentral zone (1.65–4 mm) [ 25 ] . This case report preliminarily explores the long-term impact of prior refractive surgery on corneal astigmatism after cataract surgery. However, our conclusions are inherently limited by single-case observations. Further validation of the effects of corneal refractive surgery on postoperative corneal astigmatism prediction bias and prolonged recovery periods necessitates additional long-term follow-up studies involving larger cohorts. Future studies should expand sample sizes, investigate the enduring effects of various refractive procedures (e.g., LASIK, PRK, SMILE), and refine preoperative formulas to increase the accuracy of astigmatism correction. Furthermore, clinical practice should ensure thorough preoperative counseling on potential risks and individualized treatments for such patients. Conclusion This case illustrates the considerable influence of a history of refractive surgery on the recovery from postoperative corneal astigmatism. Patients with a history of refractive surgery are at greater risk of prediction errors and a longer recovery period when monofocal, multifocal, or extended-depth-of-focus toric IOLs are used. Therefore, personalized biometric measurement protocols and IOL power calculation methods should be employed, with careful selection of surgical techniques and IOL types. Preoperative counseling must address the potential risks of postoperative astigmatic fluctuations and long-term management strategies, emphasizing the need to establish long-term follow-up protocols. Declarations Ethics Approval and Consent to Participate All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration. Consent for publication Written informed consent was obtained from the patient for the publication of this case report and its accompanying images. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding Supported by the Natural Science Foundation of Shanghai (Research Project of Science and Technology Commission of Shanghai Municipality; grant numbers 22ZR1410400 and 19ZR1408600); the National Natural Science Foundation of China (grant numbers 81300747 and 82101103); the “Young Clinical Scientist Training Program” (Shanghai Medical College, Fudan University; grant number 2023, DGF828019-2/038); the Excellent Young Doctor Training Program of Shanghai (2015–2018), Shanghai Municipal Health Commission; the Scientific Research Program of Shanghai Pudong New Area Health Commission (the Joint Research and Development Program, grant number PW2024D-05); and the “Medicine + X” Interdisciplinary Research Project of Tongji University (grant number 2025-0553-YB-07). Author contributions TY.Zheng is the guarantor of the study, supervised the work, and administered the project. CX.Li and F.Yang conceptualized the study. PM.Lin, ZH.Xie, SY.Tang, Jie.Xu and YY.Qiu were involved in drafting and editing the manuscript. CX.Li, YY.Qiu and TY.Zheng reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Causes of blindness and vision impairment. in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study [J]. Lancet Glob Health. 2021;9(2):e144–60. Global estimates on the number of. Eye (Lond). 2024;38(11):2156–72. people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020 [J]. Cicinelli MV, Buchan JC, Nicholson M, et al. Cataracts [J] Lancet. 2023;401(10374):377–89. Keshav V, Henderson BA. Astigmatism Management with Intraocular Lens Surgery [J]. Ophthalmology. 2021;128(11):e153–63. Xue J, Pan A, Shao X, et al. 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Indian J Ophthalmol. 2021;69(10):2650–6. Ma J, Wang Y, Wei P, et al. Biomechanics and structure of the cornea: implications and association with corneal disorders [J]. Surv Ophthalmol. 2018;63(6):851–61. Diniz D, Andrade FMX, Chamon W, et al. Corneal suture for acute corneal hydrops secondary to post-LASIK ectasia: a case report [J]. Arq Bras Oftalmol. 2020;83(6):538–42. Pantanelli SM, Lin CC, Al-Mohtaseb Z, et al. Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia: A Report by the American Academy of Ophthalmology [J]. Ophthalmology. 2021;128(5):781–92. Shetty N, Sathe P, Aishwarya, et al. Comparison of intraocular lens power prediction by American Society of Cataract and Refractive Surgery formulas and Barrett True-K TK in eyes with prior laser refractive surgery [J]. Indian J Ophthalmol. 2024;72(8):1210–3. Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.doc Table2.doc Table3.doc Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 02 Feb, 2026 Reviewers agreed at journal 19 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 16 Dec, 2025 Editor assigned by journal 15 Dec, 2025 Submission checks completed at journal 15 Dec, 2025 First submitted to journal 14 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":611014,"visible":true,"origin":"","legend":"\u003cp\u003eA, Preoperative B-scan Ultrasound of the Right Eye; B, Preoperative B-scan Ultrasound of the Left Eye; C, Postoperative B-scan Ultrasound of the Right Eye; D, Postoperative B-scan Ultrasound of the Left Eye\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/ba4d5f93c52ec38a0ef5b3f4.png"},{"id":100008588,"identity":"e214d986-c772-4f1c-9d10-5598898cc880","added_by":"auto","created_at":"2026-01-12 05:55:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53496,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA: \u003c/strong\u003ePreoperative Corneal Endothelium Microscopy (Right Eye); B: Preoperative corneal endothelium microscopy (left eye)\u003c/p\u003e","description":"","filename":"Onlinefigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/bab991289958eb95d489593d.png"},{"id":100008580,"identity":"3f76387e-f25e-412c-a627-d88e8ef0d8e5","added_by":"auto","created_at":"2026-01-12 05:55:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":869737,"visible":true,"origin":"","legend":"\u003cp\u003eA: Intraocular lens (IOL) rotation; B: Proper IOL position after repositioning surgery\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/432f84f92765be24cd961103.png"},{"id":100008581,"identity":"2eb6c589-a9ee-45d2-8e87-09eba49d3d15","added_by":"auto","created_at":"2026-01-12 05:55:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26848,"visible":true,"origin":"","legend":"\u003cp\u003eA, Preoperative-to-postoperative changes in corneal astigmatic vector (PCAV) changes over time; B, Corneal astigmatism changes over time\u003c/p\u003e","description":"","filename":"Onlinefigure4.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/bc9bd348acec8c55c53403a8.png"},{"id":100008576,"identity":"a3555aa2-9b9e-4da3-b08f-f6b70a2db0e4","added_by":"auto","created_at":"2026-01-12 05:55:21","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":138786,"visible":true,"origin":"","legend":"\u003cp\u003ePentacam Reports of Preoperative and Postoperative Follow-up\u003c/p\u003e\n\u003cp\u003eA: Preoperative; B: 1 Month Postoperative; \u0026nbsp;C: 2 Months Postoperative; D: 3 Months Postoperative; E: 10 Months Postoperative\u003c/p\u003e","description":"","filename":"Onlinefigure5.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/a3db921883bddc4693ede2ef.png"},{"id":100008583,"identity":"a1e92e25-faaf-497b-9b94-653ee2a8fb93","added_by":"auto","created_at":"2026-01-12 05:55:21","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":20325,"visible":true,"origin":"","legend":"\u003cp\u003eLine Graphs of Key Parameter Changes Over Time\u003c/p\u003e","description":"","filename":"Onlinefigure6.png","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/92568970925d1e979c67c551.png"},{"id":100380787,"identity":"a91663c6-6169-477e-8299-33c9a197053a","added_by":"auto","created_at":"2026-01-16 10:34:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2963975,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/5bc7bbc0-d3e9-469c-aa1e-0e75f371a641.pdf"},{"id":100008571,"identity":"75bc5463-5ce9-46ec-88b5-b3ef3a529591","added_by":"auto","created_at":"2026-01-12 05:55:20","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27648,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.doc","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/2cbc25775031e54995bdc105.doc"},{"id":100008573,"identity":"74cafd43-c2b3-4743-9f7a-d1fe2bbd1864","added_by":"auto","created_at":"2026-01-12 05:55:20","extension":"doc","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":32256,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.doc","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/d7486f0637277dc6fcafcee6.doc"},{"id":100361732,"identity":"e96cb557-6491-464b-8411-cb0bcdee1d81","added_by":"auto","created_at":"2026-01-16 07:45:38","extension":"doc","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":28672,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.doc","url":"https://assets-eu.researchsquare.com/files/rs-8356913/v1/3421291e5d7bf5c84922e8dd.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Abnormal Increase in Corneal Astigmatism after Cataract Surgery in a Post-LASIK Eye: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCataracts remain one of the leading causes of blindness worldwide\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Epidemiological data indicate that the prevalence of and blindness rates associated with cataracts have significantly increased due to population aging, with a 30% increase in cataract-induced blindness from 20002020\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Over 40% of cataract patients present astigmatism of \u0026ge;\u0026thinsp;1.00 diopters (D), which, if left untreated, substantially impairs visual acuity\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. With advancements in technology and research, astigmatism can now be predicted and corrected using toric IOLs\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Toric IOLs are capable of correcting astigmatism\u0026thinsp;\u0026ge;\u0026thinsp;1.50 D\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e and are currently widely used among cataract patients with corneal astigmatism.\u003c/p\u003e \u003cp\u003eA measurable discrepancy in corneal astigmatism before and after surgery is expected with standard cataract procedures. We used vector analysis to evaluate the preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs). Typically, the observed differences in corneal astigmatism before and after cataract surgery result primarily from surgical incisions that induce differential changes in refractive power along various meridians and lead to changes in corneal astigmatism, which is formally termed surgically induced astigmatism (SIA). Studies have reported that the average SIA after microincision cataract surgery is 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 D at 1 week postoperatively, decreasing to 0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 D by 3 months\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Under normal ocular conditions, the effect of SIA is typically minimal and tolerable. Research suggests that SIA peaks in the early postoperative period (1\u0026ndash;3 weeks), decreases significantly within 3 months, and then stabilizes after 1 year\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe global prevalence of myopia is increasing due to lifestyle changes\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, leading to an increasing demand for refractive surgeries, particularly among young individuals. Over the past 25 years, an estimated 20\u0026ndash;25\u0026nbsp;million laser vision correction surgeries have been performed, with LASIK accounting for 80\u0026ndash;85% of patients\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. First successfully applied in humans in 1991\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, LASIK has experienced rapid development and market expansion. However, the earliest cohort of LASIK patients now faces age-related cataracts after 35 years. These individuals often have greater visual demands and stronger motivations for spectacle independence. However, corneal morphological changes induced by refractive surgery, such as corneal ectasia (progressive forward displacement and central steepening and thinning) and defentered ablations\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, may lead to more complicated postoperative recovery after subsequent cataract surgery.\u003c/p\u003e \u003cp\u003eCurrent studies on post-LASIK patients undergoing cataract surgery have primarily evaluated short-term astigmatic outcomes but lack follow-up data extending beyond one year. For example, some studies have suggested that, in post-LASIK eyes, SIA was greater and that recovery was slower during the early postoperative period (1\u0026ndash;3 months) than in controls; however, this significant difference diminished by 6 months\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Other studies have reported greater SIA in post-LASIK eyes but lack longitudinal data on its temporal evolution\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study presents the first documented case of abnormally exacerbated corneal astigmatism (vector change: +1.75 D) in a post-LASIK patient after cataract surgery, highlighting the complexity of postoperative recovery in this population. Additionally, this report provides extended follow-up data (10 months), confirming that astigmatism fluctuations may be alleviated over time, with a 42% decrease from 2 to 10 months postoperatively. Moreover, this is the first case combining a history involving LASIK, cataract surgery, and toric IOL repositioning. Importantly, we emphasize the importance of stability assessment in patients with prior refractive surgery, providing an evidence-based reference for preoperative counseling (noting an estimated 30% probability of reoperation) and surgical planning (such as the selection of toric IOLs combined with capsular tension rings).\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003e\u003cstrong\u003e(1) Case Presentation\u003cbr\u003e\u003c/strong\u003eThe patient was a 54-year-old male administrative staff member who presented with a two-year history of unexplained progressive vision decline and blurred vision in his right eye. He requested complete spectacle independence for both distance and near vision with simultaneous astigmatism correction. Preoperative examination revealed an uncorrected distance visual acuity of 0.3 in both eyes, with near visual acuity of J4 in the right eye and J3 in the left eye. The right eye showed no improvement with spectacle correction, whereas the left eye was correctable at 0.6. Both eyes presented normal intraocular pressure. Physical examinations revealed transparent corneas in both eyes without aqueous flare (FL(-)) or keratic precipitates (KP(-)) and a normal anterior chamber depth. The right eye presented with nuclear cataracts classified as C2N4P2 (moderate nuclear sclerosis) (Table 1). B-scan ultrasound and fundoscopic examination revealed no contraindications for cataract surgery, with normal corneal endothelial cell counts in both eyes (Figures 1 and 2). The final diagnosis was complicated cataract in the right eye.\u003c/p\u003e\n\u003cp\u003eThe patient underwent bilateral LASIK surgery for high myopia ten years prior, with good postoperative visual acuity, and remained in a low myopic state before cataract surgery. Ocular measurement parameters revealed that the patient\u0026apos;s axial length (AL=29.81 mm) and anterior chamber depth (ACD=3.57 mm) in both eyes were significantly greater than normal adult averages, indicating a high myopic ocular structure and axial myopia.\u003c/p\u003e\n\u003cp\u003eAs shown in the table below, the IOL Master 700 measured the right eye corneal astigmatism values as follows: K-value astigmatism: 0.70 D @ 63\u0026deg;, TK-value astigmatism: 0.67 D @ 52\u0026deg;; the Pentacam measured the corneal astigmatism at 3 mm in the right eye; SimK-value astigmatism: 1.6 D @ 66.0\u0026deg;, TCRP-value astigmatism: 1.7 D @ 62.6\u0026deg;, TNP-value astigmatism: 1.7 D @ 62.3\u0026deg;, and ERK-value astigmatism: 1.53 D @ 61.6\u0026deg; (Table 2). The astigmatism was relatively high with a somewhat irregular symmetrical form. There was also a significant difference in astigmatism measurements between the two devices, reflecting the complexity of the patient\u0026apos;s corneal morphology.\u003c/p\u003e\n\u003cp\u003e(2) \u003cstrong\u003eTwo surgical procedures\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eBased on preoperative examinations and the patient\u0026apos;s strong desire for spectacle independence, the first surgery, comprising phacoemulsification with intraocular lens implantation and capsular tension ring insertion, was performed on January 16, 2024. The intended toric IOL was model 909, with a planned axis alignment at 50 degrees. The ZEISS 909 IOL is a bifocal toric IOL with a spherical power of +17 D and a cylindrical power of +1.0 D. The target postoperative refractive state was -0.09 D spherical and +0.14 D cylindrical. The surgical approach included a 2.3 mm clear corneal incision at the 145\u0026deg; position, with viscoelastic injection into the anterior chamber and a 1 mm side incision at the 90-degree position. Continuous curvilinear capsulorhexis was performed with a diameter of approximately 5.3 mm.\u003c/p\u003e\n\u003cp\u003eOn the first postoperative day, the visual acuity was 0.3, with mild corneal edema. By the eighth day, the corneal edema had resolved, but uncorrected visual acuity remained at 0.3, with a best-corrected visual acuity value of 0.5 and 2.50 D of astigmatism. Pupillary dilation revealed significant IOL rotation, with the IOL axis shifting from the intended 50-degree angle to a 10-degree angle. Studies have shown that approximately 1 degree of toric IOL misalignment reduces astigmatic correction by 3.3%, and a 30\u003cstrong\u003e-degree\u003c/strong\u003e misalignment not only fails to correct astigmatism but may also exacerbate it\u003csup\u003e[15, 16]\u003c/sup\u003e. After thorough discussions with the patient, an IOL repositioning surgery was performed on January 24, 2024 (2 weeks postoperatively). Postoperative assessment verified optimal IOL alignment at the intended 50-degree axis (Figure 3, the comparison before and after repositioning).\u003c/p\u003e\n\u003cp\u003e(3) \u003cstrong\u003ePostoperative follow-up\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe patient underwent multiple follow-up examinations, with the longest follow-up period extending to 10 months. The examination instruments used primarily included an IOL Master 700 and a Pentacam, which measure six corneal astigmatism parameters: keratometry astigmatism (K), total keratometry astigmatism (TK), simulated keratometry astigmatism (SimK), true corneal refractive power astigmatism (TCRP), total net power astigmatism (TNP), and equivalent keratometry astigmatism (ERK). One month after the operation (0.5 months following repositioning), the patient\u0026apos;s uncorrected visual acuity was 0.4, which was correctable to 0.8+ and had a refractive error of -1.75/-1.50 \u0026times; 180\u0026deg;. Pupillary dilation confirmed the IOL axis at 50\u0026deg;, and Pentacam showed increased corneal astigmatism (SimK 2.1 D, TCRP 2.3 D) compared with the preoperative values. At 2 months post-surgery, uncorrected visual acuity improved to 0.7, with a best-corrected visual acuity of 0.8+ and a refraction error of -1.50/-1.50 \u0026times; 170. Pentacam demonstrated further increases in corneal astigmatism (SimK 2.3 D, TCRP 2.6 D), and IOL Master measurements also revealed significant increases in corneal astigmatism (K: 1.92 D, TK: 2.25 D) compared with the preoperative values. By 3 months post-surgery, uncorrected visual acuity stabilized at 0.7, with a best-corrected visual acuity of 0.8 and a refraction of -1.75/-1.00 \u0026times; 165. Compared with those at 2 months, the corneal astigmatism values slightly improved but remained higher than the preoperative values. At the final 10-month follow-up, uncorrected visual acuity remained at 0.7, with a best-corrected visual acuity of 0.7 and a refraction of -1.50/-1.00 \u0026times; 175. Pentacam resulted in further reductions in corneal astigmatism values (Table 3).\u003c/p\u003e\n\u003cp\u003eA review of the patients\u0026rsquo; follow-up records revealed significant fluctuations in astigmatism. In addition to scalar measurements, to account for the vector characteristics of astigmatism, we employed the Alpin vector analysis method to calculate the PCAV for multiple corneal astigmatic parameters. The resulting fluctuation graphs for both corneal astigmatism and PCAV are illustrated in Figure 4. The maximum degree of corneal astigmatism occurred at 2 months (TNP peaked at 2.5 D), with a notable increase from 1 to 2 months. ERK showed the most pronounced change\u0026mdash;an increase of 0.34 D (a 15.1% increase). Astigmatism decreased significantly from 2 to 3 months and from 3 to 10 months, with ERK showing the most pronounced change\u0026mdash;a decrease of 0.8 D (a reduction of 30.9%). The maximum PCAV occurred at 2 months (TK peaked at 1.68 D), with a notable increase from 1 to 2 months. ERK showed the most pronounced change\u0026mdash;an increase of 0.42 D (a 56.1% increase). The PCAV decreased significantly from 2 to 3 months (ERK decreased the most (by 0.8 D, a reduction of 68.9%)). From 3 to 10 months, some PCAV parameters decreased (TK decreased by 0.46 D), whereas others increased (TNP increased by 0.3 D), with all changes being significant. Overall, the PCAV began to stabilize after 10 months. Therefore, in this post-LASIK patient, corneal astigmatism and PCAV required a minimum 10-month stabilization period following cataract surgery. Both the magnitude and the stabilization time were greater than those in normal post-cataract surgery patients.\u003c/p\u003e\n\u003cp\u003eAnalysis of preoperative and postoperative Pentacam reports (Figure 5) revealed a relatively flat central corneal curvature, reflecting a previous history of LASIK surgery. The follow-up Pentacam consistently highlighted a regular and symmetrical \u0026quot;bow-tie\u0026quot; pattern in the central cornea, with multiple Pentacams indicating with-the-rule astigmatism. Changes in astigmatism axis positioning, central corneal thickness, central corneal curvature, and total refractive power were analyzed (see Figure 6). We observed maximal surgical impact on the morphology of the incision site cornea at 2 months after surgery, with a progressive decrease thereafter. Concurrently, the global cornea also tended to flatten with the recovery of the localized incision site. Central corneal thickness and the astigmatism axis followed trends similar to those of the degree of astigmatism, peaking at 2 months postoperatively. In contrast, central corneal curvature and total corneal refractive power peaked earlier, at 1 month postoperatively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case involved a 55-year-old male who underwent bilateral LASIK surgery 10 years prior and subsequently developed progressive vision loss in his right eye over two years. He underwent phacoemulsification with toric intraocular lens (IOL) implantation, followed by postoperative IOL rotation exceeding 30\u0026deg; and persistent astigmatic fluctuations. After repositioning surgery, both the degree of corneal astigmatism and the PCAV gradually stabilized.\u003c/p\u003e \u003cp\u003eIn this case, the patient experienced IOL rotation, which emerged as a significant complication in toric IOL implantation\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. As a high myopia patient, this patient exhibited a larger capsular bag, while the elongated axial length subjected the zonules to additional mechanical stress, leading to zonular laxity and an increased risk of IOL rotation. The optimal window for toric IOL repositioning is typically 1 to 15 days postoperatively\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In this case, prompt repositioning surgery ensured timely correction of the misaligned toric IOL.\u003c/p\u003e \u003cp\u003eThe abnormally elevated and prolonged fluctuations in postoperative corneal astigmatism may be attributed to multiple factors. Although the second surgery did not alter the incision size or configuration, it may have delayed wound healing, potentially impacting corneal and intraocular structural stability and thereby influencing postoperative corneal astigmatism\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Additionally, a history of refractive surgery can lead to irreversible corneal changes, including reduced biomechanical strength and iatrogenic corneal ectasia (corneal thinning, protrusion, and irregular astigmatism)\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, which may contribute to exaggerated postoperative corneal astigmatism. This case illustrates how preexisting corneal biomechanical alterations from refractive surgery resulted in an atypical response to surgical incisions. The incision site biomechanical modifications propagated through corneal stress redistribution, ultimately inducing global corneal abnormalities. In addition, the cumulative effect of three ocular surgeries (LASIK, cataract extraction, and IOL repositioning) may have further compromised corneal biomechanical stability, increasing the risk of postoperative astigmatic fluctuations.\u003c/p\u003e \u003cp\u003eIn addition to the astigmatic changes induced by surgical incisions, the abnormal increase in corneal astigmatism in this case may involve more complex contributing factors. A prior report indicated delayed corneal ectasia six years after LASIK, progressing to acute corneal edema\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, suggesting that subtle interstitial corneal edema may exist under the LASIK flap and influence corneal astigmatism in this case. Analysis of corneal thickness changes revealed a parallel trend with astigmatism, peaking at 20 days postoperatively before gradually stabilizing, confirming that LASIK cataract surgery indeed alters corneal thickness and impacts astigmatism. Moreover, calculation formula-derived errors may also contribute to the abnormal increase in postoperative corneal astigmatism. Although the Barrett True-K formula reduces the MAE to 0.5\u0026ndash;0.7 D (vs. 0.7\u0026ndash;1.2 D with conventional formulas), its accuracy remains suboptimal in post-LASIK eyes, with only 65% within \u0026plusmn;\u0026thinsp;0.5 D versus virgin eyes\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Finally, LASIK-induced central corneal flattening may introduce measurement errors in keratometry, as the IOL Master evaluates the paracentral zone (1.65\u0026ndash;4 mm)\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis case report preliminarily explores the long-term impact of prior refractive surgery on corneal astigmatism after cataract surgery. However, our conclusions are inherently limited by single-case observations. Further validation of the effects of corneal refractive surgery on postoperative corneal astigmatism prediction bias and prolonged recovery periods necessitates additional long-term follow-up studies involving larger cohorts. Future studies should expand sample sizes, investigate the enduring effects of various refractive procedures (e.g., LASIK, PRK, SMILE), and refine preoperative formulas to increase the accuracy of astigmatism correction. Furthermore, clinical practice should ensure thorough preoperative counseling on potential risks and individualized treatments for such patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case illustrates the considerable influence of a history of refractive surgery on the recovery from postoperative corneal astigmatism. Patients with a history of refractive surgery are at greater risk of prediction errors and a longer recovery period when monofocal, multifocal, or extended-depth-of-focus toric IOLs are used. Therefore, personalized biometric measurement protocols and IOL power calculation methods should be employed, with careful selection of surgical techniques and IOL types. Preoperative counseling must address the potential risks of postoperative astigmatic fluctuations and long-term management strategies, emphasizing the need to establish long-term follow-up protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the publication of this case report and its accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupported by the Natural Science Foundation of Shanghai (Research Project of Science and Technology Commission of Shanghai Municipality; grant numbers 22ZR1410400 and 19ZR1408600); the National Natural Science Foundation of China (grant numbers 81300747 and 82101103); the \u0026ldquo;Young Clinical Scientist Training Program\u0026rdquo; (Shanghai Medical College, Fudan University; grant number 2023, DGF828019-2/038); the Excellent Young Doctor Training Program of Shanghai (2015\u0026ndash;2018), Shanghai Municipal Health Commission; the Scientific Research Program of Shanghai Pudong New Area Health Commission (the Joint Research and Development Program, grant number PW2024D-05); and the \u0026ldquo;Medicine + X\u0026rdquo; Interdisciplinary Research Project of Tongji University (grant number 2025-0553-YB-07).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTY.Zheng is the guarantor of the study, supervised the work, and administered the project. CX.Li and F.Yang conceptualized the study. PM.Lin, ZH.Xie, SY.Tang, Jie.Xu and YY.Qiu were involved in drafting and editing the manuscript. CX.Li, YY.Qiu and TY.Zheng reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCauses of blindness and vision impairment. in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study [J]. Lancet Glob Health. 2021;9(2):e144\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal estimates on the number of. Eye (Lond). 2024;38(11):2156\u0026ndash;72. people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020 [J].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCicinelli MV, Buchan JC, Nicholson M, et al. Cataracts [J] Lancet. 2023;401(10374):377\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeshav V, Henderson BA. Astigmatism Management with Intraocular Lens Surgery [J]. Ophthalmology. 2021;128(11):e153\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXue J, Pan A, Shao X, et al. Efficacy of toric intraocular lens implantation in individuals with cataracts and asymmetric corneal astigmatism [J]. Photodiagnosis Photodyn Ther. 2025;52:104515.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark HJ, Lee H, Woo YJ, et al. Comparison of the Astigmatic Power of Toric Intraocular Lenses Using Three Toric Calculators [J]. Yonsei Med J. 2015;56(4):1097\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller KM, Oetting TA, Tweeten JP, et al. Cataract in the Adult Eye Preferred Practice Pattern [J]. Ophthalmology. 2022;129(1):P1\u0026ndash;126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Q, Li R, Feng L et al. Long-Term Visual Quality after Microincision Cataract Surgery [J]. J Ophthalmol, 2020, 2020: 9318436.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJonas JB, Ang M, Cho P, et al. IMI Prevention of Myopia and Its Progression [J]. Invest Ophthalmol Vis Sci. 2021;62(5):6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoffe SN. The 25th Anniversary of Laser Vision Correction in the United States [J]. Clin Ophthalmol. 2021;15:1163\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePallikaris IG, Papatzanaki ME, Siganos DS, et al. A corneal flap technique for laser in situ keratomileusis. Human studies [J]. Arch Ophthalmol. 1991;109(12):1699\u0026ndash;702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahay P, Bafna RK, Reddy JC, et al. Complications of laser-assisted in situ keratomileusis [J]. Indian J Ophthalmol. 2021;69(7):1658\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao X, Zhang J, Han W. A Comparative Study of the Effect of Femtosecond Laser-Assisted Cataract Surgery on Corneal Astigmatism in Post-LASIK Eyes and Virgin Eyes [J]. Clin Ophthalmol. 2024;18:1655\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarslioglu MZ, Kesim C, Tas AY, et al. Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes [J]. Arq Bras Oftalmol. 2023;86(5):e20230070.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchallhorn SC, Hettinger KA, Pelouskova M, et al. Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients [J]. J Cataract Refract Surg. 2021;47(8):991\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTitiyal JS, Kaur M, Jose CP, et al. Comparative evaluation of toric intraocular lens alignment and visual quality with image-guided surgery and conventional three-step manual marking [J]. Clin Ophthalmol. 2018;12:747\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNa KS, An D, Kim HS, et al. Relation between change of effective lens position and toric IOL rotation after toric IOL implantation [J]. Can J Ophthalmol. 2025;60(1):8\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin X, Ma D, Yang J. Insights into the rotational stability of toric intraocular lens implantation: diagnostic approaches, influencing factors and intervention strategies [J]. Front Med (Lausanne). 2024;11:1349496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOshika T, Inamura M, Inoue Y, et al. Incidence and Outcomes of Repositioning Surgery to Correct Misalignment of Toric Intraocular Lenses [J]. Ophthalmology. 2018;125(1):31\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Kim EK, Kim HS, et al. Fourier-domain optical coherence tomography evaluation of clear corneal incision structure according to blade material [J]. J Cataract Refract Surg. 2014;40(10):1615\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenia VP, Kenia RV, Pirdankar OH. Short term changes in corneal stress-strain index and other corneal biomechanical parameters post-laser in situ keratomileusis [J]. Indian J Ophthalmol. 2021;69(10):2650\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa J, Wang Y, Wei P, et al. Biomechanics and structure of the cornea: implications and association with corneal disorders [J]. Surv Ophthalmol. 2018;63(6):851\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiniz D, Andrade FMX, Chamon W, et al. Corneal suture for acute corneal hydrops secondary to post-LASIK ectasia: a case report [J]. Arq Bras Oftalmol. 2020;83(6):538\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePantanelli SM, Lin CC, Al-Mohtaseb Z, et al. Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia: A Report by the American Academy of Ophthalmology [J]. Ophthalmology. 2021;128(5):781\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShetty N, Sathe P, Aishwarya, et al. Comparison of intraocular lens power prediction by American Society of Cataract and Refractive Surgery formulas and Barrett True-K TK in eyes with prior laser refractive surgery [J]. Indian J Ophthalmol. 2024;72(8):1210\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Corneal astigmatism, Cataract surgery, Preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs), LASIK surgery, Toric intraocular lens","lastPublishedDoi":"10.21203/rs.3.rs-8356913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8356913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: To investigate the impact of prior corneal refractive surgery on visual quality after phacoemulsification with toric intraocular lens (toric IOL) implantation.\u003c/p\u003e\n\u003cp\u003eCase presentation: We report the case of a 55-year-old male with a history of bilateral LASIK who underwent phacoemulsification with toric IOL implantation for cataracts and astigmatism in the right eye, with a focus on the diagnosis and management of intraocular lens rotation and astigmatism fluctuations postoperatively.\u003c/p\u003e\n\u003cp\u003eResults: The patient exhibited an abnormal increase in preoperative-to-postoperative changes in corneal astigmatic vectors (PCAVs) after cataract surgery and toric IOL implantation due to lens rotation, requiring IOL repositioning. Postoperative corneal astigmatism showed an abnormal increase of 1.75 D but gradually stabilized after an extended recovery period.\u003c/p\u003e\n\u003cp\u003eConclusions: A history of refractive surgery significantly affects postoperative corneal astigmatism during cataract surgery, increasing prediction errors and prolonging postoperative recovery in toric IOL patients. Cautious patient selection and thorough preoperative consultation are essential.\u003c/p\u003e","manuscriptTitle":"An Abnormal Increase in Corneal Astigmatism after Cataract Surgery in a Post-LASIK Eye: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 05:55:15","doi":"10.21203/rs.3.rs-8356913/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-02T06:30:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49244680051825609974828229099537438464","date":"2026-01-19T06:41:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T05:11:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-16T05:23:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-15T05:25:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-15T05:25:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-12-14T08:49:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a24fc90-3624-498e-a45c-48e8b808f7e0","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T05:55:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 05:55:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8356913","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8356913","identity":"rs-8356913","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}