Nuclear cataract, moderate oblique corneal astigmatism, and glaucoma in a highly myopic eye implanted with a foldable...

A 65-year-old woman had undergone bilateral foldable iris-fixated phakic intraocular lens (pIOL) implantation in 2008 to correct for high myopia of -10 diopters (D). 12 years later, she presented with nuclear and subcortical cataract in her right eye. The Artiflex pIOL (Figure 1JOURNAL/jcrs/04.03/02158034-202111000-00021/figure1/v/2021-10-20T185516Z/r/image-tiff) was well centered and fixed to the iris. Endothelial cell count (ECC) was 2159 per mm2 and corneal thickness 515 µm. Residual correction in her distance glass was -1.75 + 1.5 × 60. Topography showed a symmetric bowtie with a mean simulated keratometry of 1.3 D at an axis of 67 degrees (Figure 2JOURNAL/jcrs/04.03/02158034-202111000-00021/figure2/v/2021-10-20T185516Z/r/image-tiff). Keratometry was 1.5 @ 65. Left eye refraction was -1.5 + 1.0 × 175. The patient had also developed chronic open-angle glaucoma with intraocular pressure measurements exceeding 30 mm Hg, which was currently regulated with topical medication. What would be your surgical approach for cataract surgery with IOL removal and replacement when also considering the possible later need for superior glaucoma filtering surgery?