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A 74-year-old man with a preoperative manifest refraction of −3.00 +1.00 × 25 had cataract extraction and implantation of a toric intraocular lens (IOL). Although the IOL power was chosen according to the surgical records and accurately aligned on the target axis at the follow-up examination, the incision apparently induced enough surgically induced astigmatism (SIA) to make the cornea spherical. The patient was dissatisfied with the resulting flipped axis and 20/60 uncorrected acuity. Intraoperative aberrometry confirmed that the cornea was now spherical. An IOL exchange was performed with placement of a 22.0 diopter nontoric IOL. The second surgery was complicated by early capsule phimosis. Because it can measure true aphakic corneal astigmatism intraoperatively, intraoperative aberrometry can be useful in preventing IOL exchanges due to anomalous SIA. Financial Disclosure The author has no financial or proprietary interest in any material or method mentioned.

Intraoperative aberrometry-assisted toric IOL exchange following unexpected surgically induced astigmatism