Keratoconus Following Cataract Extraction: A Patient-Centered Perspective

Keratoconus is one of the most common forms of corneal ectasia. In severe cases, patients experience significant visual impairment, which can be further exacerbated by the development of cataracts. This deterioration may not only impact their vision but also affect their emotional well-being and mental health. Here, we report a case of a patient with severe keratoconus who underwent cataract surgery in both eyes, leading to a remarkable transformation in her life. An 80-year-old woman with underlying hypertension initially presented with bilateral blurring of vision and elevated intraocular pressure (IOP). She was diagnosed with bilateral primary angle closure glaucoma (PACG) and was started on antiglaucoma treatment, with cataract extractions planned. Before surgery, she was semi-dependent and experienced frustration and depression due to her deteriorating vision. The preoperative assessment revealed keratoconus, with cylindrical power of -10.00DC in the right eye and -9.00DC in the left eye. She consented to monofocal toric intraocular lens (IOL) implantation. Postoperatively, her cylindrical power was significantly reduced to -2.50DC in the right eye and -1.50DC in the left eye. Her vision improved markedly despite underlying PACG and tunnel vision. The patient now feels more independent and her quality of life has significantly improved. Careful biometry calculations, thorough planning, and patient counseling are essential for achieving optimal postoperative outcomes in cataract surgery for stable keratoconus patients. This case highlights that significant astigmatism correction due to keratoconus is possible in selected individuals, improving both vision and overall quality of life.