Posters

Algorithm for planning intraocular lens based surgery in stable and progressing keratoconus

Poster Details

First Author: Z.Ashena UK

Co Author(s): J. Harding   R. Casey-Knight   C. Yvon   M. Nanavaty           

Abstract Details

Purpose:

Accurate intra-ocular lens selection and refractive outcome prediction is challenging in keratoconus due to variation in keratometry and astigmatism. We propose an algorithm with flowchart to facilitate decision making in lens-based surgery in patients with keratoconus.

Setting:

Sussex Eye Hospital, Brighton, UK

Methods:

Comprehensive literature search conducted for papers on intraocular lens based procedures in keratoconus. An algorithm was created based on stability of keratoconus, crystalline lens status, rigid contact lens tolerability and  location of the cone.

Results:

Patients with stable keratoconus, good best spectacle corrected visual acuity, clear crystalline lens and intolerance to contact lens are offered implantable contact lens (ICL). We recommend non-toric ICL in central, paracentral and peripheral cone and toric ICL in paracentral cone with fairly regular astigmatism. Patients with stable keratoconus and cataract benefit from non-toric intraocular lens (IOL) in central, paracentral or peripheral cone and toric IOL in paracentral cone with regular astigmatism. In progressing keratoconus, corneal crosslinking should be offered in suitable eyes. Where crosslinking is not possible, a sequential/combined keratoplasty and cataract surgery is offered depending on severity of cataract.

Conclusions:

We present a detailed algorithm with flowchart as a guide to surgeons for lens based surgery in stable and progressing keratoconus. This algorithm will help corneal surgeons in comprehensive pre-operative planning for the surgery taking into account factors such as progression, BSCVA, keratometry, topography and apex location of the cone in keratoconic patients

Financial Disclosure:

None