THERAPEUTIC REFRACTIVE SURGERY USING A CUSTOMIZED HIGH POWER IOL FOR HIGH ERROR OF REFRACTION IN A PREVIOUS KERATOPLASTY AND PREVIOUS PHAKIC IOL IMPLANT KERATOCONUS PATIENT WITH CATARACT.

A 40-year-old man with keratoconus, high myopia, and astigmatism in both eyes underwent keratoplasty on the right eye (1999) and left eye (2000) where the surgeries were generally unremarkable. In 2007, he underwent phakic intraocular implantation (pIOL) surgery on both eyes. Anterior segment examination showed a NO3 cataract, and an ICL well placed with good vault on the right eye and a NO4 cataract with an ICL well placed with good vault on the left eye. Patient underwent Bilensectomy on both eyes and with the Biotech customized lens implanted due to the available cylinder power matching the patient’s high astigmatism. Scleral incision was created to remove the phakic IOL and the scleral wound was closed with a continuous non-interrupted suture using nylon 10/0 sutures. Phacoemulsification was done and the IOL was inserted and then positioned to obtain a precise alignment of the IOL axis marks with the markings on the limbus done preoperatively.