Cataract surgery considerations in patients with prior history of keratoconus and ectasia

Abstract

Purpose of reviewPreoperative workup for cataract surgery in patients with keratoconus poses certain challenges, particularly in patients with moderate-to-severe disease. This review aims to outline the appropriate preoperative, intraoperative, and postoperative considerations and provides an algorithm to help guide the workup prior to surgery.Recent findingsA new system for keratoconus progression and staging has been proposed and additional studies comparing intraocular lens (IOL) formulas calculations and biometry devices have been conducted.SummaryPatients with severe keratoconus have unpredictable results and have an increased risk of a hyperopic refraction postoperatively. Although studies have compared IOL calculation formulas, there is no consensus on management. Clinical considerations and an approach to the workup are presented; however, additional studies are required to determine the most appropriate management of cataracts in severe keratoconus.

Corneal Disease and its Impact on Cataract Surgery

“…Contact lenses can distort the cornea and as such need to be discontinued prior to preoperative measurements. Soft contacts should be discontinued for at least 1 week [55] and rigid gas permeable (RGP) lenses should be discontinued for 1-2 weeks for every decade of use [56]. Patients with progressive disease may be candidates for corneal crosslinking (CXL) which has been shown to help strengthen the cornea by forming…”

“…After reviewing the available data comparing these devices, Moshirfar et al published a paper ultimately recommending obtaining Pentacam measurements, comparing them across more than one device and selecting the measurements that result in the highest calculated IOL power. Doing so reduces the risk of hyperopic surprise postoperatively [56].…”