Bilateral microcornea and unilateral macrophthalmia resulting in incorrect intraocular lens selection

A 79-year-old man with symmetrical microcornea and a dense unilateral nuclear sclerotic cataract had cataract extraction by phacoemulsification. The SRK/T formula suggested a 10.0 diopter (D) intraocular lens (IOL) for emmetropia (axial length 26.58 mm). The non-cataract eye required a 25.0 D IOL for emmetropia (axial length 21.51 mm). Biometric measurements were rechecked, and an 18.0 D IOL was implanted (axial length 24.02 mm). The 6 week postoperative refraction of -13.0 + 2.0 x 25 necessitated IOL exchange (10.0 D). Six weeks postexchange, the refraction was -3.75 + 2.5 x 30. This illustrates that symmetrical anterior microphthalmos does not always coexist with symmetrical posterior microphthalmos. Awareness of the association of symmetrical microcornea and unilateral colobomatous macrophthalmia may aid appropriate IOL selection in future cases.