Choosing The Right Intraocular Lens In Patients With Corneal Ectasia
Published 2023 - 41st Congress of the ESCRS
Reference: PO0424 | DOI: 10.82333/mw2w-e441
Authors: Andrei Comber* 1 , Catalina Corbu 2 , Vasile Potop 3 , Valeria Coviltir 3 , Mihaela Constantin 2 , Maria Marinescu 3 , Dana Dascalescu 3
1Ophthalmology,Clinical Hospital for Ophthalmological Emergencies ,Bucharest,Romania, 2Ophthalmology,Oftaclinic,Bucharest,Romania, 3Ophthalmology,Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology,Clinical Hospital for Ophthalmological Emergencies ,Bucharest,Romania
Keratoconus (KC) is known as a progressive non-inflammatory corneal ectatic disorder, usually bilateral and asymmetric. It associates characteristic cone-shaped steepening of the cornea with stromal thinning, resulting in irregular astigmatism.
We present the case of a 61 year old female patient that presented for a slowly progressive visual acuity loss over the last 2 years. Ocular history includes both eyes (OU) keratoconus and systemic history includes arterial hypertension and diabetes mellitus type 2.
We performed a complete ophthalmologic examination that included uncorrected visual acuity (VA) measurement: right eye (RE) = 0.3 Snellen, left eye (LE) = 0.2 Snellen. Intraocular pressure (IOP): RE = 14 mmHg, LE = 16 mmHg. Anterior segment examination showed a Fleischer ring OU, medium-high anterior chamber depth (ACD), posterior subcapsular opacification of the lens LE>RE, while OU fundus examination revealed a cup/disc ratio=0.6, attached retina, constricted arterioles and dilated venules.
Paraclinical investigations showed: central corneal thickness RE = 420 microns, LE = 425 microns; corneal topography OU astigmatism, RE: K1=44.97 D, K2= 47.21 D; LE: K1=44.82 D, K2=48.07 D.
After clinical and paraclinical examinations, the following diagnostics have been established: OU keratoconus RE stage I and LE stage I-II (Amsler Krumeich classification) and posterior subcapsular cataract LE>RE, hypertensive retinopathy grade I. We decided to perform cataract surgery LE first with a monofocal toric intraocular lens (IOL) implantation. Biometry was performed using the topographic measurements and a Holladay formula was used for the toric IOL calculation, with a small myopic target. 2 weeks results showed a VA 1 Snellen without correction.
Cataract surgery and especially the biometry in patients with corneal ectasia represents a challenge for any surgeon. The risk for refractive surprise is higher in keratoconus patients and the right IOL choice can be difficult due to the corneal irregularities, thin cornea and tear film deficiency. Although patients can have good visual acuity, even with a small residual refractive error, they tend to tolerate a myopic refractive surprise rather than a hyperopic result. Using topographic data for the biometry may prove to be a better option in these cases. Choosing a monofocal toric IOL may be a safer option than a multifocal toric IOL in these patients.
Acknowledgements: All authors had equal contribution.