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Preoperative planning needed for keratoconus patients with cataracts

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WAIKOLOA, Hawaii — Patients with cataracts and keratoconus need to be taken through a specific preoperative assessment before undergoing cataract surgery, according to a speaker here.

First, patients must properly be diagnosed with keratoconus or post-LASIK ectasia, William B. Trattler, MD, said at Hawaiian Eye 2019.

“Preoperative topography is critical. It is important to do topography on every patient to properly diagnose keratoconus,” he said.

The surgeon must also identify patients with dry eye or conditions that may affect corneal mapping, such as epithelial basement membrane dystrophy or Salzmann’s nodular degeneration, Trattler said.

It is important to remember that if a patient is diagnosed with keratoconus, using the standard IOL formulas will often result in hyperopia.  So it is best to target for mild myopia.  As well, patients with keratoconus can in some cases be candidates for a toric IOL, such as when the axis and power of astigmatism is consistent on multiple measurements, Trattler said.

If corneal cross-linking is being considered in a patient with advanced cataract, cataract surgery should usually be performed before cross-linking, he said.

“If the cataract is very visually significant, it makes sense to do the cataract surgery first, target myopia and then deal with the cross-linking. The cross-linking can take months to years to work to get a shift or change in the corneal shape. If you end up at a target of –1.5 D or –2 D and then come back 4 months later and have cross-linking, then over time your cornea will slowly reshape and will be stable,” he said. – by Robert Linnehan

Reference:

Trattler WB. Preoperative planning in keratoconus patients with cataracts. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.

Disclosure: Trattler reports he has a financial interest in CXLO and Avedro and is a speaker and does consulting for Avedro.