Purpose: To study the refraction achieved after same-day bilateral cataract surgery, particularly with regard to anisometropia and the incidence of patient dissatisfaction caused by this complication. Setting: Department of Ophthalmology, University Hospital of Linköping, Sweden. Methods: This was a retrospective study of 165 consecutive patients who had bilateral cataract surgery on the same day. Parameters examined were preoperative and postoperative visual acuity and refraction (spherical equivalent), preoperative keratometry and axial lengths, planned postoperative refraction, difference between planned and achieved refraction, anisometropia, and recorded evidence of patient dissatisfaction resulting from refraction or binocularity problems. Results: Postoperative refraction was within ±0.5 diopter (D) from target in 43%, ±1 D from target in 71%, and ±2 D from target in 95% of eyes. Anisometropia was =0.5 D in 48% of patients and =1 D in 82% of patients. Two patients (1.2%) had anisometropia >2 D. No patient returned with complaints caused by postoperative refraction. Conclusions: Although deviation from planned postoperative refraction occurred in several cases, no patient reported binocularity problems in the 1% of cases with significant anisometropia. Risk for deviation from planned refraction does not appear to be a contraindication to same-day bilateral phacoemulsification in patients without known risk factors. © 2004 ASCRS and ESCRS.