Visual Outcomes Of Toric Multifocal Intraocular Lens Implantation In A Patient With Bilateral Anterior Lenticonus

To discuss a case of bilateral anterior lenticonus  managed with clear lens extraction and toric multifocal intraocular lens implantation

A tertiary care ophthalmology institute (Advanced Eye Centre ,Post Graduate Institute of Medical Education and Research, Chandigarh ) in North India

An 18year old female presented with  bilateral diminution  of vision for  3 years associated with hearing loss. Uncorrected distance visual acuity (UDVA) was 20/200 OU. Corrected distance visual acuity (CDVA) improved to 20/60 OU with a refractive error of -0.50 D Sph/-2.75 D Cyl X155⁰ OD and -0.50 D Sph/-2.55 D Cyl X 180⁰ OS. Slit lamp biomicroscopy revealed anterior lenticonus which was confirmed on swept source OCT. Fundus examination was unremarkable.

Aberrometry performed on the I Trace revealed high internal aberrations and a low dysfuntional lens index implicating  lenticular aberrations as the cause of low vision . For visual rehabilitation the patient was advised a clear lens extraction with toric multifocal IOL implantation as she was desirous of spectacle independence.

After confirming symmetric ‘with the rule astigmatism’ on topography the patient underwent sequential  clear lens extraction with implantation of Synergy toric multifocal intraocular lenses (+16.5D ZFW300 model OD  followed 4 weeks later by  +17 D DFW 375 model OS). Post operatively  UDVA improved from 20/200  to 20/30 OU and CDVA  improved to 20/20 with a refractive correction 0f -0.50 D Cyl X180⁰ OU; uncorrected intermediate and near visual acuity improved to N8 and N6  respectively.

Nephrology consultation detected  no renal involvement at present and the patient was advised an annual follow up and targeted exome sequencing  for Alport’s syndrome which she  decided to undergo at a later date .