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HELP! Which lens should I choose!?

Poster Details

First Author: D. Vuijk THE NETHERLANDS

Co Author(s):    I. van der Meulen   R. Lapid   M. Sirks              

Abstract Details


To report an IOL (intraocular lens) calculation in an eye which has severe keratoconus with K values above 60D and cataract in a patient refusing a corneal transplantation.


Academic department of Ophthalmology, Amsterdam UMC, location AMC, Amsterdam, the The Netherlands.


Case report of a patient with severe keratoconus, cataract, CL intolerance and who wants to avoid a corneal transplantation. A biometry and pentacam were done. The IOL was calculated with the Barrett Universal II formula. The average central 3mm K-values were used. The target refraction was -2.0D. Preoperatively the patient had a refraction of OD S-3,50 C-5,50x105 BCVA 0,4 and OS S-4,00 C-3,50x70 BCVA0,4. Patient was still using CL in the OS, so the target of -2.0D was agreed upon. Cataract surgery was uneventful and a SN60WF (Alcon, USA) of 7.0 D was implanted.


The target reached was: OD S+0.50 C-3.00x078 , DCVA 0,3; OS S-4,00 C-4,00x085 DCVA 0,5), but patient complained of aneisokonia and aneisometropia. Patient decided to defer planned surgery in the OS. CL intolerance OD precluded CL wear. IOL exchange was deemed risky. After shared consent an add on ICL was chosen to harmonize refraction between the eyes. An ICL (Staar, Switzerland) was calculated for a refraction of spherical -3.00, without correction of the cylinder. Postoperatively patient was OD S-2,75 C-4,00x060 BCVA 0,2; OS S-4.00 C-4.00x085 BCVA 0,6.


IOL calculation in keratoconus is notoriously difficult, and even when reaching the agreed target refraction, in keratoconus patients satisfaction with vision is difficult. In order to alleviate anisometropia and aneisokonia, an ICL off label add on was successfully performed. Visual acuity did not improve, but patient satisfaction with ability to wear glasses was subjectively greatly improved. In both instances, IOL calculation proved accurate, but patient perception differed from intention.

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