27 EyeWorld Asia-Pacific | December 2024 CATARACT Cataract surgery in patients with keratoconus presents a challenge in the presurgical, intraoperative, and postoperative stages. Refractive outcomes are notoriously difficult to predict despite careful preoperative planning, and patients with irregular corneas often require postoperative correction with rigid contact lenses for their best visual acuity and quality of vision. Recent developments, such as newer-generation keratoconus-specific IOL formulas and advanced lens technology (including the Light Adjustable Lens and aperture optics), hold promise for improving outcomes for these patients. Yet, significant challenges remain. For this YES Connect column, we queried two experts regarding how they proceed with cataract surgery in patients with keratoconus and how they leverage the latest technology to maximize outcomes for this unique patient population. —Eric Weinlander, MD, Guest Editor, YES Connect by Ellen Stodola, Editorial Co-Director Cataract Surgery In Patients With Keratoconus When performing cataract surgery in patients with keratoconus, there are considerations for surgical planning, lenses, and techniques that surgeons need to account for to ensure success. In this issue’s YES Connect column, Nandini Venkateswaran, MD, and Neel Pasricha, MD, discussed how they handle these patients, including testing, formulas, and IOL selection. Potential problems of preexisting keratoconus Dr. Venkateswaran shared the major challenges in eyes with keratoconus undergoing cataract surgery. There is always the concern for ongoing keratoconus progression. She said to ensure that the keratoconus is stable prior to proceeding with cataract surgery, as ongoing keratometric changes can lead to refractive changes and blurred vision post-cataract surgery. In addition, given the degree of ectasia and possible corneal scarring, the view for cataract surgery can be difficult, and trypan blue to stain the anterior capsule can be helpful. A suture in the main wound is often needed given corneal elasticity changes. Finally, she shared that IOL calculations are an ongoing challenge. She’ll advise patients of the risk of refractive surprises, even with modern-day formulas. She also advises patients that they will likely need to use glasses or hard contact lenses after surgery, based on the degree of keratoconus/ ectasia for best vision. Dr. Pasricha also discussed several challenges of performing cataract surgery in patients with keratoconus: intraocular lens selection, choosing the correct formula, and surgical technique modification.
RkJQdWJsaXNoZXIy Njk2NTg0