Intraocular lens exchange for vision-dependent vestibular disorder after cataract surgery: A case report

Dissatisfaction after cataract surgery is often attributed to psychosomatic factors when no ophthalmologic abnormalities are detected, and visually induced vestibular dysfunction is rarely considered. We report a rare case in which such dysfunction was identified and successfully treated by restoring the preoperative refractive state through intraocular lens (IOL) exchange. A 79-year-old woman who had undergone bilateral cataract surgery at another hospital presented with persistent blurred vision, dizziness, and a floating sensation despite good postoperative acuity. She had mild preoperative myopia (spherical equivalent approximately −2.0 D) and no history of spectacle use. Stabilometry revealed abnormal postural sway under rubber-load conditions, indicating strong visual dependence. To simulate her preoperative state, +3.5 D contact lenses were trialed bilaterally, resulting in marked symptom relief. Five months after the original surgery, bilateral IOL exchange was performed (+23.0 D NX70S), targeting her habitual refractive state. Postoperative corrected distance visual acuity was 1.2 in the right eye (sph −2.0; cyl −1.0 × 96°) and 1.2 in the left eye (sph −1.75; cyl −0.75 × 87°) (all visual acuity values reported in decimal), with marked resolution of subjective symptoms. Follow-up stabilometry showed improvement: locus length per unit area (eyes open), 44.73; Romberg ratio for area, 0.61; and velocity Romberg ratio under rubber-load, 1.65. No symptom recurrence was observed at 26 months. In visually dependent patients, substantial changes in habitual refractive state may exacerbate vestibular symptoms. In such cases, IOL exchange may alleviate visually induced vestibular dysfunction by restoring the preoperative refractive error. • Visually induced vestibular dysfunction can cause post-cataract dissatisfaction • Symptoms occurred despite good acuity and no ocular abnormalities • Stabilometry revealed strong visual dependence in a myopic patient • Simulating preoperative refraction relieved dizziness and visual discomfort • IOL exchange restoring habitual refraction resolved symptoms long term