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A patient with keratoconus had cataract extraction and intraocular lens (IOL) implantation in both eyes. The IOL power was determined using keratometric values (K-values) measured by standard keratometry in the right eye and videokeratography in the left eye. The ideal IOL power and the K-value that would have led to the ideal IOL power were determined from the postoperative refraction at 6 weeks. The ideal K-value was compared with the K-values derived from videokeratography and standard keratometry. Refraction at 6 weeks postoperatively was 5.60 and 1.00 diopter more myopic than the aim in the right and left eye, respectively. The mean power in ring 3 in videokeratography of the left eye was the same as the ideal K-value calculated using the Holladay formula. Determining IOL powers with videokeratography-derived K-values might be more accurate than standard keratometry in patients with keratoconus.

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PURPOSE/METHODS: To report a patient who developed hyperopic progression in one eye and myopic regression in the other eye following bilateral, non-simultaneous refractive keratotomy. RESULTS: Uncorrected visual acuity improved to 20/25 and 20/25-2 in the right and left eyes, respectively, 3 months following refractive keratotomy (one procedure in the right eye, two procedures in the left eye). The visual acuity was not stable over time and almost 8 years after surgery, uncorrected distance visual acuity was 20/40- and 20/200. The spherical equivalent refraction of the right eye progressed from -0.50 diopter (D) 3 months after surgery to +1.25 D several years later. The left eye regressed from a spherical equivalent refraction of -0.75 D 3 months after the second surgery to -2.50 D more than 7 years postoperatively. Slit-lamp microscopy disclosed deeper, opaque incisions in the hyperopic eye, and shallower and more transparent incisions in the myopic eye. CONCLUSIONS: The shift toward hyperopia and myopia in an individual suggest that instability of the radial keratotomy wound may be related to local wound healing events that are, in part, related to incision depth. [J Refract Surg. 1996;12:160-162.]