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Tailored reduction of coma, irregular astigmatism and myopia with sequential double femtolaser-assisted surgery in patient with bilateral keratoconus, cataract and anisometropia

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Session Details

Session Title: FLACS II

Session Date/Time: Monday 07/09/2015 | 14:30-16:00

Paper Time: 15:54

Venue: Room 16

First Author: : L.Gualdi ITALY

Co Author(s): :    V. Cappello   F. Gualdi   M. Gualdi              

Abstract Details


To regularise the corneal coma aberration induced by keratoconus with a single inferior corneal ring inserted in correspondance of the coma axis, sequentially followed by a complete restoration of vision reducing the remaining sphero-cylindrical error by a toric IOL on the residual corneal astigmatism axis.


D.O.M.A. srl (Rome - Italy)


Corneal topo-tomography and aberrometry (OPD-scanIII,Sirius,Pentacam,Casia) were examined. Both corneal coma and astigmatism axis were differently divided. The first was chosen in correspondance to a channel created by femtosecond laser (Intralase 150kh) where an inferior Intacs SK 300 corneal ring was inserted in the first eye. Once regularizated and stabilized the corneal astigmatism, after 4 months a femtosecond assissted cataract surgery (FLACS) with LenSx and a Acrysof T9 toric IOL on the astigmatism axis was performed aiming for micro-monovision. In the fellow eye an on-axis clear corneal incision with FLACS and a Acrysof T5 was performed aiming for plano correction.


The post-operative result was uneventful and 1 week after the second eye surgery the uncorrected far vision was 16/20 in the first eye and 20/20 in the second eye. Bilaterally the patient could see 20/20 and J1 at 35 cm without any correction due to the negative asphericity, the residual vertical coma and depth of field induced by the keratoconus. The patient completely eliminated either contact lens and glasses dependence.


Patients with keratoconus submitted to cataract surgery always are destined to remain with residual regular and mainly irregular astigmatism. After cataract surgery the residual regular astigmatism can be corrected by glasses while irregular astigmatism only with tailored lens. In a demanding patient or in case of contact lens intollerance, the insertion of intracorneal rings can be an option to reduce the irregularity of the astigmatism. In this case, the strategy was very important, being corrected the coma axis with the ring first, not considering the astigmatism axis which was then corrected by the FLACS surgery with a toric IOL.

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