Comprehensive Visual Rehabilitation In A Patient With Advanced Keratoconus And Cataract: Combined Surgical And Optometric Management
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR387 | Type: Poster | DOI: 10.82333/r6mh-h029
Authors: Mrs Margarita Cabanás Jiménez* 1 , Mrs Elena María Gámez Jiménez 2 , Mr José Antonio Aragón Amador 2 , Mrs Teresa Romero Luna 3 , Mrs Marta Romero Luna 3
1Clínica Baviera,Seville,Spain;Ophthalmology,Virgen del Rocío University Hospital,Seville,Spain, 2Ophthalmology,Virgen del Rocío University Hospital,Seville,Spain, 3Clínica Baviera,Seville,Spain
Purpose
To describe the clinical and functional outcomes of a combined surgical and optometric approach in a highly myopic patient with advanced keratoconus and bilateral corticonuclear cataracts, aiming to achieve meaningful visual rehabilitation in a complex pluripathological scenario.
Setting
Tertiary referral ophthalmology centre and private refractive surgery clinic in Seville, Spain.
Methods
A highly myopic patient with advanced keratoconus and progressive bilateral visual loss was evaluated. Preoperatively, uncorrected visual acuity was limited to hand movements. Subjective refraction was −30.00 D (right eye) and −23.00 D (left eye), achieving 0.05 decimal acuity with poor quality. With rigid gas-permeable lenses, acuity reached 0.2 and 0.1. Biomicroscopy showed marked inferior corneal thinning and bilateral corticonuclear cataracts. Sequential management included bilateral phacoemulsification with planned aphakia, followed by intrastromal corneal ring segment implantation and subsequent semi-scleral rigid gas-permeable lens fitting after refractive stabilisation.
Results
Phacoemulsification was uneventful in both eyes. Corneal ring implantation improved corneal regularity, allowing more reliable refractive assessment. After stabilisation and semi-scleral lens fitting (12.70 mm diameter), corrected visual acuity improved to 0.4 in the right eye and 0.7 in the left eye. The patient reported marked subjective improvement in visual quality and daily functioning compared with the preoperative condition.
Conclusions
In selected cases of advanced keratoconus with cataract and associated ocular comorbidities, meaningful visual rehabilitation can be achieved through a staged strategy combining cataract surgery, intrastromal corneal ring implantation, and semi-scleral contact lenses. A tailored multidisciplinary approach may optimise functional outcomes in complex pluripathological eyes.