Visual And Refractive Outcomes Of Bilateral Toric Intraocular Lens Implantation For Cataract In A Patient With Keratoconus : A 1 Year Follow-Up Case Report

To report visual and refractive outcomes following bilateral monofocal toric intraocular lens(IOL) implantation in a patient with asymmetric keratoconus and cataract, emphasizing the role of keratoconus-specific IOL calculators and careful preoperative counseling in achieving predictable results.

Tertiary care eye hospital , North India

Cataract surgery in a patient with preexisting asymmetric keratoconus(KC) presents a challenge for achieving optimal visual outcomes. A 73-year-old female patient presented to us with painless, progressive vision loss in both eyes for several months with a long standing history of poorer vision in her left eye(LE) as compared to right eye(RE). She was diagnosed with immature cataracts in both eyes with early KC in RE and severe KC with corneal scarring in LE. Pre op refraction in RE was -0.75 DS/-2.25DC@180 & LE was -1.25DS/-4DC@90 with BCVA RE 6/12 & LE 6/36.Corneal tomography (Anterion) revealed mild KC changes in RE and severe corneal steepening and thinning in her LE.Patient desired spectacle-free vision; however, she was thoroughly counseled about her ocular condition and possible need for glasses postoperatively. Given the corneal irregularity and ocular status,a monofocal toric IOL was preferred over an EDOF lens. IOL power calculation and astigmatism correction were planned using two keratoconus-specific online calculators- Barrett True-K toric and Kane keratoconus calculator.TECNIS monofocal toric IOLs were implanted for both eyes. Postoperative follow-up included UCVA, BCVA and refraction.Postoperatively, UCVA improved to 6/6 in the right eye and 6/24 in the left eye. BCVA was 6/6 (right) and 6/18 (left), with a residual −1.5D cylinder in the left eye. There were no intraoperative or postoperative complications, and visual acuity remained stable at 1-year follow-up.

Toric IOL implantation can be a safe and effective option for cataract surgery in patients with keratoconus, including severe cases. Careful preoperative planning using corneal topography and keratoconus-specific toric calculators is critical for achieving optimal refractive outcomes. This case demonstrates that significant visual improvement is possible even in eyes with irregular corneal curvature and amblyopia. Thorough preoperative counseling helped set realistic expectations regarding visual outcomes and the potential need for glasses, complementing meticulous planning to achieve predictable results.