How to get Started with: Arcuate Incisions Limbal Relaxing Incisions

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Cataract Surgery in Keratoconus: How to approach? William Trattler, MD Director of Cornea Center For Excellence In Eye Care Miami, FL

Photo courtesy of Richard Awdeh

Disclosures • • • • • • •

Bausch and Lomb: Consulting, Research, & Speaking Allergan: Consulting, Research, and Speaking AMO: Consulting and Research CXLUSA: Consulting Oculus: Speaking LensAR: Consulting Oculus: Speaking

How to approach a patient with Keratoconus who has a visually significant cataract

Variety of approaches for Keratoconus & Cataracts … Considerations

Crosslinking First

•Time Course for stabilization of corneal shape following crosslinking?

Cataract Surgery First

Advantage: Rapid improvement in vision following cataract surgery Can perform crosslinking 3 to 6 months later

Significant Variability of Corneal Shape following CXL • Progressive flattening of corneal shape over 1 to 3 years….. – K’s are never quite stable

• How long should you wait after CXL to perform cataract surgery?

Next Challenge • What type of IOL? – Monofocal • What are the advantages?

– Toric • When can you consider a toric IOL?

Patient with a visually significant cataract: Toric IOL? LRI?

Avoid Toric IOL or Corneal Incisions Consider Crosslinking postop….

60 yr old male with keratoconus and cataracts?

Avoid Corneal Incisions Consider monofocal IOL followed by Crosslinking

63 year old female with vis sig cataract – would like to reduce need for distance lenses Which approach (if any) would you recommend?

Central Astigmatism Relatively Regular

TORIC IOL placed: T7 at axis 170 • UCVA = 20/20 at postop day 5 – Patient very pleased with quality of vision – No monocular diplopia

Summary: Keratoconus & cataracts • Consider cataract surgery first • Crosslinking is effective in older patients – Can perform after cataract surgery