Cataract surgery considerations in patients with prior history of keratoconus and ectasia

Purpose of reviewPreoperative workup for cataract surgery in patients with keratoconus poses certain challenges, particularly in patients with moderate-to-severe disease. This review aims to outline the appropriate preoperative, intraoperative, and postoperative considerations and provides an algorithm to help guide the workup prior to surgery.Recent findingsA new system for keratoconus progression and staging has been proposed and additional studies comparing intraocular lens (IOL) formulas calculations and biometry devices have been conducted.Patients with severe keratoconus have unpredictable results and have an increased risk of a hyperopic refraction postoperatively. Although studies have compared IOL calculation formulas, there is no consensus on management. Clinical considerations and an approach to the workup are presented; however, additional studies are required to determine the most appropriate management of cataracts in severe keratoconus.

Automated summary

Preoperative workup for cataract surgery in patients with keratoconus is challenging, especially in those with moderate-to-severe disease. This review outlines the appropriate considerations and presents an algorithm to guide the preoperative workup. Recent studies have proposed a new system for keratoconus progression and staging, as well as compared intraocular lens formulas and biometry devices.