Our Focus

This comprehensive review addresses the complexities of managing cataract surgery in keratoconus patients. It provides evidence-based strategies for preoperative assessment, intraoperative techniques, and postoperative care to optimize visual outcomes in this challenging patient population.

What is it about?

This paper comprehensively analyses the complexities involved in performing cataract surgery on patients with keratoconus. It discusses:

• Preoperative Planning: Emphasizes the importance of stabilizing the cornea using methods such as corneal collagen cross-linking (CXL), intrastromal corneal ring segments (ICRS), and topography-guided treatments to enhance the accuracy of biometric measurements. The paper also highlights the challenges in obtaining reliable measurements, particularly in the advanced stages of KCN, and the need for individualized surgical approaches based on the severity and stability of the disease.
• Intraoperative Considerations: Addresses the technical difficulties encountered during surgery, such as image distortion and loss of visual perspective, which can be alleviated using rigid gas permeable (RGP) lenses. The choice between toric and monofocal intraocular lenses (IOLs) is discussed, with recommendations for various situations presented. • Postoperative Management: Highlights the potential need for updated RGP or scleral lenses to correct residual corneal irregular astigmatism.

Why it matters

Keratoconus patients present unique challenges during cataract surgery due to corneal irregularities and the potential for early-onset cataracts, often exacerbated by factors like chronic steroid use. Accurate IOL power calculation is complicated, increasing the risk of suboptimal visual outcomes. This review provides a structured approach to address these challenges, aiming to improve surgical outcomes and patient satisfaction.

Citation

Nicholson M, Murthy S, Gatinel D, Singh V, Pereira S, Pradhan A, Vasavada S, Dandekar P. Current concepts in the management of cataract with keratoconus. Indian Journal of Ophthalmology. 2024 Feb 23.