SMALL APERTURE INTRAOCULAR LENS FOR CATARACT IN POST-LASIK ECTASIA - A CASE REPORT
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO189 | Type: Presented Poster & Poster | DOI: 10.82333/91pp-tz19
Authors: Nuno Moura-Coelho* 1 , José Güell 2
1Cornea and Refractive Surgery Unit,IMO Barcelona Grupo Miranza,Barcelona,Spain;NOVA Medical School,Lisbon,Portugal, 2Cornea and Refractive Surgery Unit,IMO Barcelona Grupo Miranza,Barcelona,Spain;Universidad Autonoma de Barcelona,Barcelona,Spain
Purpose
To report a case of cataract surgery in a post-LASIK ectasia case with implantation of a small aperture IOL
Setting
Cornea and Refractive Surgery Unit - Private practice.
Methods
A 59 year-old female patient was referred to our center for progressive worsening of visual acuity in her left eye. Her ophthalmic history was relevant for myopic LASIK surgery nearly 20 years earlier.
At presentation, best-corrected spectacle visual acuity (BSCVA) was 20/25 (2-) in her right eye (OD) and 20/40 (1-) in her left eye (OS) with -3.00 D sph -4.00 D cyl (35º). Rigid gas-permeable contact lens best-corrected visual acuity was 20/30 (1-). On slit-lamp examination, the cornea was clear and a corticonuclear cataract was present bilaterally; fundus examination was normal in both eyes. Corneal topography was consistent with post-LASIK ectasia with significant irregular astigmatism in both eyes.
The decision was to perform cataract surgery first in OS, with implantation of a small aperture acrylic hydrophobic IOL (IC-8®, Bausch and Lomb). Multiple IOL formulae were used for IOL power calculations, and IOL power selection aimed for a slight myopic outcome.
Results
The cataract surgery was performed in OS uneventfully by one experienced surgeon (N.M-C.), with implantation of the IC-8 IOL via a 3.5-mm posterior limbal incision in the steep axis sutured with interrupted sutures. Postoperative evolution was uneventful. Two weeks after suture removal (14 weeks postoperative), uncorrected distance visual acuity in OS was 20/25 (1-), and BSCVA was 20/25 with a residual refraction of +0.50 D sphere. The patient is now awaiting cataract surgery in OD.
Conclusion
To the best of the authors' knowledge, this is the first reported case of small aperture IOLs in the management of post-LASIK ectasia. Small aperture IOLs are effective for the improvement of vision and irregular astigmatism in cases of corneal ectasia and cataract. In our case, significant improvement of refractive cylinder was observed, however we suggest that refractive predictability be addressed with the patient preoperatively.