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Cataract surgery with toric intraocular lens implantation in patients with keratoconus

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First Author: M.Vandevenne THE NETHERLANDS

Co Author(s):    V. Webers   M. Vandevenne   N. Visser   N. Bauer   R. Nuijts        

Abstract Details


To evaluate clinical outcomes following toric intraocular lens (IOL) implantation in patients with cataract and keratoconus


University Eye Clinic Maastricht, the Netherlands


A total of thirty-six eyes of 25 patients with stable mild to moderate keratoconus (Krumeich stage 1 and 2) underwent cataract surgery with toric IOL implantation (Acrysof SN6AT3-T9 or Rayner T-flex). Postoperatively uncorrected and best-corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), Alpins vector analysis, surgically induced corneal astigmatism, posterior corneal astigmatism and IOL misalignment were evaluated.


The mean preoperative CDVA was 0.39 ± 0.26logMAR and mean corneal astigmatism 3.88 ± 1.30D (range 1.42 to 6.38D). Postoperatively, UDVA and CDVA were 0.21 ± 0.13logMAR and 0.11 ± 0.11logMAR, respectively. The mean residual refractive astigmatism was -1.27 ± 0.97D and the mean MRSE 0.09 ± 0.82D (range -0.88 to 2.63D). The mean correction index of 1.20 ± 0.21 (range 0.75 to 1.61) and magnitude of error of 0.42D indicate a general overcorrection. In 19% of eyes the magnitude of overcorrection of corneal astigmatism was ≥1.0D. In 4 eyes, a secondary reposition was performed to treat ≥10° of misalignment.


Cataract surgery with toric IOL implantation is an effective treatment option in patients with mild to moderate, stable keratoconus. However, care should be taken to prevent overcorrection.

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