Current concepts in the management of cataract with keratoconus.

This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.

Cataracts.

94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.

Scleral fixation of a foldable intraocular lens with polytetrafluoroethylene sutures through a Hoffman pocket.

UNLABELLED: Scleral fixation of intraocular lenses (IOLs) is traditionally performed after conjunctival dissection and preparation of scleral flaps. The Hoffman pocket technique creates scleral pockets without conjunctival dissection. We describe a technique that uses a Hoffman pocket and 7-0 polytetrafluoroethylene (Gore-Tex) sutures for scleral fixation of a foldable posterior chamber IOL in patients with insufficient capsule support. The technique eliminates the need for conjunctival dissection, scleral cauterization, knot rotation, and sutured wound closure. The favorable properties of the suture material and the use of a small incision to insert a foldable IOL are additional advantages. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Cone location-dependent outcomes after combined topography-guided photorefractive keratectomy and collagen cross-linking.

PURPOSE: To evaluate the effect of keratoconus cone location on the change in refractive outcomes, corneal aberrations, and biomechanics after combined topography-guided photorefractive keratectomy (PRK) and collagen cross-linking (CXL). DESIGN: Prospective, comparative case series. METHODS: Topography-guided PRK was performed followed by accelerated CXL using riboflavin A and enhanced-intensity (30 mW/cm(2)) ultraviolet light. Outcome parameters including uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BDVA), corneal tomography and biomechanics (corneal hysteresis [CH] and corneal resistance factor [CRF]), and corneal wavefront aberrations were assessed before and a year after the procedure. Eyes were subdivided into 2 groups preoperatively for statistical analysis: Group 1, cone located within the central 2-mm zone; and Group 2, cone located outside the central 2-mm zone. RESULTS: UDVA, BDVA, sphere, cylinder, and simulated keratometry improved after treatment in both groups (P < .05). However, BDVA improved more in Group 1 than in Group 2 (P = .04) and the other variables were not affected by cone location. A few corneal wavefront Zernike aberrations changed after treatment (P < .05) but none were affected by cone location (P > .05). CH and CRF increased after treatment in both groups (P > .05). Interestingly, the increases in CH and CRF were greater in Group 2 than in Group 1 (P > .05). CONCLUSIONS: Cone location appeared to impact only visual acuity and biomechanics after the combined procedure. The greater increase in CH and CRF in Group 2 may indicate differences in the ablation profile and variability in CXL outcomes and requires further study.