Troubleshooting the postoperative IOL result.

1. We all experience disappointment when a patient's postoperative visual result differs from the anticipated refraction. Although it is easy to initially place blame on an A-scan measurement, keratometer reading or an incorrect IOL calculation, our frustration may be tempered by applying a few basic troubleshooting steps. 2. There are several reasons for determining the cause for the discrepancy. First is to address the potential need for an IOL exchange if the refraction is dramatically unacceptable. Second, information gained from analysis of the first eye's results can aid in more accurately predicting an IOL power for the patient's fellow eye. A third reason is to learn from our mistakes to prevent their recurrence. A step-by-step analysis provides an unemotional method for reaching a much needed conclusion. 3. Ask yourself the following questions: Do pre- and postoperative measurements make sense and correlate with patient history? Are A-scan echo patterns and electronic caliper placement correct? Have correct values been entered into the formula?