Cataract Surgery in Keratoconus

Cataract and keratoconus are commonly encountered during the clinical practice; its management will be reviewed by discussing first the preoperative planning aiming to provide the patients with the best postoperative uncorrected visual acuity. Corneal crosslinking and intrastromal corneal ring segments may be considered preoperatively to stabilize the cornea and improve its shape. Second, keratometry, axial length measurements, and IOL power calculation formulas will be reviewed. As keratoconus stage progresses, the accuracy of these measurements was proved to be less reliable. Nowadays, toric IOL is commonly used in early cases of keratoconus, while monofocal IOL is preferred in advanced disease. Third, intraoperative hints will be given to improve the surgeon’s visualization, to decrease the risk of complications and avoid inducing corneal irregularities following cataract surgery. Finally, postoperative visual rehabilitation is a necessity, and the surgeon may consider IOL exchanges, corneal surgeries, or rigid gas permeable contact lens to correct any residual refractive errors, hence helping the patients achieve their best visual potential.