Cataract Surgery in Patients with Keratoconus: Pearls and Pitfalls

Area of Science:

• Ophthalmology
• Corneal Ectasias
• Cataract Surgery

Background:

• Keratoconus (KC) is a progressive corneal thinning disorder.
• KC patients experience earlier lens opacities, increasing cataract surgery likelihood.
• KC complicates standard cataract surgery due to irregular astigmatism and unreliable biometry.

Purpose of the Study:

• To address challenges in intraocular lens (IOL) selection for keratoconus patients.
• To improve refractive outcome prediction in cataract surgery for KC eyes.
• To evaluate the efficacy of toric IOLs in keratoconus.

Main Methods:

• Biometric data acquisition in KC eyes.
• Analysis of IOL power calculation methods for irregular corneas.
• Assessment of toric IOL outcomes in keratoconus patients.

Main Results:

• Accurate biometry is challenging in KC due to unreliable keratometry (K) measurements.
• Existing biometric formulas may not be suitable for KC eyes.
• Toric IOLs show potential but are only effective in selected low-grade KC cases.

Conclusions:

• Staging keratoconus is critical for surgical planning.
• Pre-operative patient counseling is essential for managing expectations.
• Careful selection of refractive correction methods and IOLs is crucial for successful outcomes and patient satisfaction in KC cataract surgery.