Сataract Surgery After Penetrating Keratoplasty Due To Keratoconus With Corneal Graft Local Clouding

To present the clinical outcomes of using an enhance depth of focus IOL for cataract surgery in a patient after penetrating keratoplasty (PKP) with corneal graft local clouding to a previous fungal corneal ulcer.

The study was conducted on the basis of the S. Fyodorov Eye Microsurgery Federal State Institution.

A 28-year-old male was consulted with decreased vision in his left eye. In the 2020 OS history of PKP for keratoconus stage 4. In 2021, he had fungal keratitis on his left eye, which was treated successfully with medical therapy. However, the local clouding of corneal graft was formed. Visual acuity OS before surgical treatment was 0.05 sph -10.0 cyl -4.0 ax 30 = 0.1. Slit lamp examination showed clouding of the cornea graft in the racentral zone, clouding in the nuclear-cortical layers of the lens. Keratometry data showed the presence of astigmatism OS 47.12 diopters - 6°, 51.32 diopters - 96°, pachymetry: thinning in the zone of clouding OS - minimum thickness 384 μm. The IOL was calculated using three different calculators (Barrett Toric Calculator, Alcon Online Toric IOL Calculator, Kane Formula). The patient underwent cataract phacoemulsification in the left eye using a femtosecond laser with implantation of a Vivity toric lOL (Alcon). 6 months after surgery, UCVA (5 m) OS 0.5, UCVA (66 cm) 0.4, UCVA (33 cm) 0.3. Distance visual acuity (5 m) with correction cyl -0.75 ax 155 = 0.8. Subjective assessment of visual functions was carried out using the Visual Function – 14 questionnaire and amounted to 91%, which indicates the patient’s satisfaction with the result.

The presented results indicate sufficient predictability and effectiveness of the use of lenses with enhance depth of focus IOLs in patients with corneal pathology.