Implantation of an additional intraocular lens for keratoconus in a pseudophakic eye

BACKGROUND: In the accessible literature sources, there is insufficient information on the correction of refraction abnormalities in cases of keratoconus, due to which exploring the modern approaches in the implantation of additional intraocular lenses, including the choice of indications, the surgical technique and the post-operative follow-up, gains major importance for managing the patients with this disease. CLINICAL CASE DESCRIPTION: The patient G., aged 42 years, presented with the complaints of decreased visual acuity in the left eye. Past medical history of progressing decreased visual acuity in both eyes from 2018, the diagnosis set was the following: “Right eye (OD): keratoconus stage I, left eye (OS): keratoconus stage II”. In 2018, the implantation of intrastromal corneal ring segments in both eyes was conducted, in 2019 — refractive lensectomy with the implantation of the AcrySof IQ Toric SN6AT8 intraocular lens (Alcon, USA) in both eyes. The examination results in the OS upon presenting were the following: non-corrected visual acuity 0.05, maximum corrected visual acuity 0.5; autorefractometry: sph +2.25 D; cyl -9.50 D ax 81°; intraocular pressure — 17 mm.Hg. For correcting the refractive error that is preventing from achieving the high visual acuity (far vision), the implantation of additional intraocular lenses was carried out (Sulcofix Toric Care group, India). The results of examining the OS during the first 24 hours after surgery were the following: non-corrected visual acuity of the OS 0.8; autorefractometry: sph -0.25 D; cyl -14.50 D ax 81°; intraocular pressure — 17 mm.Hg. CONCLUSION: The implantation of additional Sulcofix Toric intraocular lenses have demonstrated its efficiency in correcting the refractive error in the pseudophakic eye with keratoconus, however, due to the irregular astigmatism characteristic for keratoconus, the residual defect can still persist.