Cataract surgery in keratoconus: current challenges and future directions.

Area of Science:

• Ophthalmology
• Anterior Segment Surgery
• Corneal Disease

Background:

• Keratoconus presents unique challenges for cataract surgery.
• Accurate intraocular lens (IOL) power calculation is difficult due to corneal irregularities.

Purpose of the Study:

• To review recent evidence (2020-2025) on IOL power calculation, surgical strategies, and adjunctive treatments for cataract surgery in keratoconus patients.
• To highlight current limitations and future perspectives in this challenging surgical setting.

Main Methods:

• Systematic review of recent literature (2020-2025).
• Analysis of advancements in keratoconus-specific IOL formulas.
• Evaluation of surgical strategies and adjunctive treatments.

Main Results:

• Keratoconus-specific formulas (e.g., Barrett True-K, Kane-KC) improve refractive accuracy but prediction errors persist.
• Toric IOLs are effective in selected cases; multimeasurement calculators enhance astigmatic prediction.
• Staged approaches (e.g., intracorneal rings, cross-linking, DALK) improve safety and predictability.
• AI-based calculators and premium IOLs show promise but need further validation.

Conclusions:

• Outcomes in keratoconus cataract surgery are less predictable than in normal eyes.
• Patient selection, specialized formulas, and staged surgical strategies are crucial.
• Future research should focus on prospective formula validation, AI integration, and adjustable optics.