TITLE:
Management of Refractive Surprise with Add-On IOL Implantation Following Cataract Surgery
AUTHORS:
Abdelhamid Ghunaim, Mohammed Allawi, Ali Zimmermann
KEYWORDS:
Add-On IOL, Piggyback IOL, Cataract Surgery, Phacoemulsification, Refractive Surprise, Secondary IOL
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.15 No.10,
September
30,
2026
ABSTRACT: Background: To describe a case of significant refractive surprise following cataract surgery, complicated by significant postoperative anisometropia, successfully managed with a sulcus-fixated add-on intraocular lens (IOL). A 70-year-old male presented with significant postoperative myopia following cataract surgery due to an incorrect intraocular lens (IOL) power implantation. In the right eye, uncorrected visual acuity (UCVA) was 20/200, with a myopic refractive surprise of approximately −2.375 D spherical equivalent. Following implantation of a sulcus-fixated add-on IOL, uncorrected visual acuity (UCVA) improved to 20/20 with a residual spherical equivalent of approximately −0.375 D. Postoperatively, the patient achieved spectacle independence for distance vision without any significant visual symptoms and used reading glasses only for near vision. Conclusion: In this patient, a sulcus-fixated add-on IOL provided effective and reversible correction of a significant postoperative refractive surprise.