Rapid Bilateral Anterior Subcapsular Cataract In Vernal Keratoconjunctivitis Without Chronic Steroid Exposure: Short-Term Outcomes After Trifocal Iol Implantation

To report rapid bilateral anterior subcapsular cataract in vernal keratoconjunctivitis (VKC) without prolonged corticosteroid exposure and to evaluate short-term outcomes following trifocal intraocular lens (IOL) implantation in a young patient.

An 18-year-old male with a 4–5 year history of VKC presented with progressive visual decline and glare since 6 months.The patient was compliant with anti-allergic therapy and denied long-term steroid use. The corrected distance visual acuity (CDVA) was 6/36 in the right eye (RE) and 6/18 in the left eye (LE). Slit-lamp examination revealed bilateral central anterior subcapsular opacities with quiet anterior segments and normal posterior segment.

An 18-year-old male with a 4–5 year history of VKC presented with progressive diminution of vision and glare.The patient was compliant with anti-allergic therapy and denied chronic corticosteroid use.  The CDVA was 6/36 (RE) and 6/18 (LE). 

Slit-lamp examination showed bilateral central anterior subcapsular opacities with finger-like protrusions. The ocular surface and anterior chamber was quiet and corneas were clear. Dilated pupils measured 7 mm bilaterally.Posterior segment was unremarkable. Biometry revelaed 2.6D corneal astigmatism in left eye.

Sequential phacoemulsification was performed under topical anesthesia without intraoperative complications.

Postoperative Outcomes

At 1 month, UCVA improved to 6/6 N6 (RE) and 6/12 N6 (LE).
At 3 months, UCVA was 6/9 N6 (RE) and 6/12p N6 (LE).

The patient reported:

• No glare
• No halos
• Comfortable near and intermediate vision
• Return to full academic and computer activities

No postoperative inflammation or early complications were observed.

Cataract in VKC is most commonly associated with prolonged corticosteroid exposure. In this case, absence of chronic steroid use and documentation of clear lenses six months prior suggest a possible inflammation-mediated or mechanical mechanism for anterior subcapsular opacification.

With controlled ocular surface inflammation and appropriate patient selection, trifocal IOL implantation can provide satisfactory short-term functional outcomes despite large pupil size.