Late Diagnosis Of Keratoconus In A 70-Year-Old Cataract Patient Successfully Managed With High-Cylinder Toric Iol Implantation

To report a rare case of previously undiagnosed keratoconus in a 70-year-old male referred for cataract surgery, successfully managed with implantation of a high-cylinder toric intraocular lens (IOL), achieving excellent visual outcome.

An eye care center in Gyumri, Armenia, specializing in cataract and vitreoretinal surgery.

A 70-year-old male presented with progressive blurry vision. Slit-lamp examination revealed age-related cataract. Preoperative refraction showed high irregular astigmatism. Corneal tomography demonstrated inferior steepening, asymmetric bow-tie pattern, increased posterior elevation, and thinning consistent with keratoconus. No prior diagnosis of ectatic disease had been made. Axial length was within normal range. The corneal astigmatism was regular and stable. After careful counseling, phacoemulsification with implantation of a toric IOL with 10.0 D cylinder power was performed. IOL power calculation incorporated tomography-based keratometry and posterior corneal astigmatism assessment.

Postoperative uncorrected visual acuity reached 20/20. Residual refractive astigmatism was negligible, and the IOL remained rotationally stable. The patient reported high satisfaction with distance vision and no visual disturbances.

Keratoconus can remain undiagnosed until late adulthood and may present during cataract workup. In carefully selected cases with stable and regular astigmatism, high-cylinder toric IOL implantation can provide excellent refractive outcomes. Comprehensive corneal imaging is essential in atypical astigmatism, even in elderly patients.