Case Reports

Pinhole lens for the management of extreme astigmatism in a patient with keratoconus, retinitis pigmentosa and cataract

Case Report Details

First Author: T.Jenyon UK

Co Author(s):    B. Ilango                    

Abstract Details

Purpose:

To describe the use of a pinhole lens in the management of 17D astigmatism in a patient with Keratoconus, cataract, and limited visual field secondary to Retinitis Pigmentosa

Setting:

New Cross Hospital, Wolverhampton, UK

Report of Case:

We report the successful management of a complex patient with both Retinitis Pigmentosa, with severely reduced visual fields, and Keratoconus. Corneal astigmatism was measured at over 17.0 D in his good right eye. He had significant scarring secondary to previous hydrops in his other left eye. In addition to these two conditions he had developed bilateral posterior subcapsular cataracts and could no longer work. His binocular vision was no greater than hand movements. He had a young family and understood his limited timeframe of good central vision due to his autosomal recessive RP. He was very keen for anything to be done to improve his vision so he could return to work. He was intolerant to contact lenses and no available toric IOL could correct this high level of astigmatism. Graft surgery was discussed but he was keen for a more immediate solution to be found. After an Individual funding request (IFR) was approved he underwent right cataract surgery with implantation of a Morcher Pin hole lens as a piggy back on top of a -10 D in the bag single piece lens. Post-operatively he complained of his vision appearing dull and grey but his acuity had improved significantly. The dullness resolved in under a week and uncorrected vision was measured at 6/36 and he was able to read N10 font unaided, and thus return to work.

Conclusion/Take Home Message:

The use of a Pinhole lens in this patient resulted is an excellent outcome. The initial ‘dull grey’ vision may have been related to the underlying RP coupled with reduced retinal light levels, but this resolved with time. The patient has now returned to work to support his family. While Pinhole lenses are not routinely available on the NHS in the UK, they can be applied for using an IFR. This case demonstrates the benefit that can be achieved by pursuing this option.

Financial Disclosure:

None