Refractive Lens Exchange In Severe Keratoconus With High Axial Myopia

Keratoconus is a common disorder in which the central or paracentral cornea undergoes progressive thinning and protrusion, resulting in a cone-shaped cornea  leading  to  irregular  astigmatism and visual deterioration. Keratoconus characteristically a bilateral but asymmetric progressive disease can be associated with axial myopia. Here we describe a case  of Keratoconus with highly irregular astigmatism with high myopic globe managed  by the Refractive  Lens Exchange procedure in our Center and its outcome.This case highlights IOL calculation in managing severe keratoconus with high myopia and its outcome which is rare of its presentation reported none before.

Patient selected was diagnosed with severe keratoconus with steep cornea and high axial myopia presented to our institute with defective vision and was planned for refractive lens exchange by normal phacoemulsification.

A  male  patient,  63 years  old,  came  to our clinic with complaints of blurred vision in both eyes with contact lens usage for past six months. Vision in Right eye 2/60 with -7.50 Dsph /-6.00x50° D cyl 6/18 and in left eye 2/60 with -11 Dsph 6/12. Corneal examination of both eyes revealed cone-shaped cornea (Keratoconus) and nuclear sclerosis grade 1 cataract. Fundus examination revealed myopic tilted disc with tesellated background. The axial length of the right eye was 27.96 mm , K1 48.95 D, K2 57.50 D, IOL power -5.50D measured by IOL master700. K reading was confirmed with orbscan measurement and axial length measurement was confirmed with b scan measurement. IOL formula used is barrette universal II.

Postoperatively lens was well centered and vision unaided is 6/36 with -3.00x150 6/12 in right eye. 

Thus even in case of severe keratoconus with high axial myopia we are able to achieve good refractive outcome with proper measurements and appropriate IOL formula