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First Author: C.Menezes PORTUGAL
Co Author(s): J. Lemos B. Vieira P. Moreira J. Serino P. Rodrigues N. Martins
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To report a particular case of corneal astigmatism correction with toric intraocular lens (TIOL) implantation at the time of cataract surgery in a patient with moderate and stable keratoconus, in which a -20ẃ degrees lens rotation did not compromise uncorrected visual acuity (UCVA).
Department of Ophthalmology - Hospital Pedro Hispano, Matosinhos, Portugal
We report a case of a 46-year-old man with bilateral Keratoconus, stable for at least 3 years and corrected with spectacles. He was referred to our department in the context of an insidious loss of vision in his right eye due to a total cataract. Best corrected visual acuity (BCVA) was perception of hand movement is his right eye and 7/10 in the left one. The corneal topographic analysis of the right eye showed a moderate keratoconus with nipple morphology and astigmatism of -3,27x20ẃ. The patient underwent cataract phacoemulsification with TIOL implantation (sphere +16,5D and cylinder +2,5D).
The cataract surgery was complicated by capsular fibrosis which dictated the need to perform an non-continuous and big capsulorrhexis with the cystotome and finished with the aid of scissors and the anterior vitrectome. A vigorous polishment of the posterior capsule was also needed. No other intercorrences ocurred and the TIOL was inserted in the capsular bag in the apropriate axis. Two weeks after the surgery, the lens was in the appropriate axis, uncorrected visual acuity (UCVA) improved to 9/10 and BCVA to 10/10 with a residual refractive cylinder of -1,25 Dx20ẃ. One month later, without any traumatic event, the lens rotated -20ẃ. Surprisingly, UCVA improved to 10/10 and BCVA to 10/10 with a residual refractive cylinder of -1,00 Dx20ẃ. No more lens rotation or keratoconus progression occurred in the following 4 months.
This is one more case showing that toric intraocular lenses can correct corneal astigmatism in cases of patients with moderate and stable keratoconus submitted to cataract surgery. However, this is a particular one, in which apart from a -20ẃ lens rotation, visual acuity was not affected and it was even improved. In our opinion, capsular phimosis and a big non-continuous capsulorrhexis might explain the lens rotation. The lens rotation repercussion, or its absence, is here the big dilemma that highlights the fact that lens power and axis calculation still remains a pearl in the management of these patients.