Cataract and progressing keratoconus — solution?

Purpose: To develop an uniform method of the treatment for patients with progressive keratoconus (stage 1‑2) and cataract.

Patients and methods: 4 patients (5 eyes) with cataract and progressive keratoconus stage 1‑2 were enrolled in the study. Mean age was 42 years. In all patients, standard ophthalmic examination as well corneal topography, anterior segment optical coherence tomography, biometry, and IOL power calculations using IOLMaster were performed. Mean uncorrected visual acuity (UCVA) was 0.1 while mean best-corrected visual acuity (BCVA) was 0.4. Surgical technique included two steps. The first step was the creation of corneal tunnels with femtosecond laser with subsequent phaco and monofocal aspheric IOL implantation. The second step (1‑2 weeks later) was the implantation of intrastromal ring segments based on corneal topography and corneal crosslinking.

Results: After the first step, all patients had myopic refraction (from –1.0 D to –2.5 D). Cylindrical component was almost unchanged. After the second step, the patients reported the vision improvement, mainly due to UCVA. Both spherical (myopic) and cylindrical components decreased, mainly due to the steep meridian. After the treatment, optical power of the cornea decreased, mainly due to the steep meridian. UCVA was 0.6 or more in 60 % of cases, final BCVA was 0.8‑1.0 in 80 % of cases. Neither intraoperative nor postoperative (follow-up was 2 years) complications were observed.

Conclusions: Combined phaco and prior creation of corneal tunnels with subsequent intrastromal ring segment implantation and crosslinking in patients with cataract and progressive keratoconus stage 1‑2 is safe, provides good predictable outcome and significantly reduces rehabilitation period.

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