Multifocal Toric IOL Implantation in Forme Fruste and Stable Keratoconus

Saturday, April 26, 2014: 3:57 PM
Room 155 (Boston Convention and Exhibition Center)
Karla P. López, MD,  Institute  of  Ophthalmology  “Conde  de  Valenciana”, Mexico City, Mexico
Margarita Montano, MD, Instituto de Oftalmologia Fundación Conde de Valenciana, Mexico City, Mexico
Alejandro Navas, MD, MSc, Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico
Arturo J. Ramirez-Miranda, MD, Instituto de Oftalmologia Conde de Valenciana, Mexico City, Mexico
Enrique O. Graue-Hernandez, MD, Instituto de Oftalmologia. Fundacion Conde de Valenciana, Mexico City, Mexico

Narrative Responses:

Purpose
To describe the visual and refractive outcomes of multifocal toric intraocular lens implantation in two patients, one with forme fruste keratoconus and another with forme frank but stable keratoconus.

Methods
A 50-year-old female with forme fruste keratoconus previously treated with corneal collagen crossliking and positive family history of keratoconus. UDVA 20/800 and 20/400 with a refraction of -5.50 -2.25 x 45 and -3.25 -1.75 x 165 respectively. The second case was a 42-year-old male with topographic diagnosis of keratoconus. UDVA 20/400 and 20/100 with a refraction of -10.25 -5.00 x 25 and - 3.50 -6.00 x 140 respectively. Refractive lens exchange was performed using multifocal toric intraocular lenses in both patients.

Results
After phacoemulsification UDVA, CDVA, Binocular UDVA and UNVA were excellent in both cases with a very mild residual refraction. The patients were subjectively very satisfied.

Our  findings  suggest  that  the  option  of  a  multifocal  toric  intraocular  lens  could  provide   optimum  outcomes,  as  these  two  cases  of  form  frustre  keratoconus  and  stable  moderate   keratoconus;;   obtaining   spectacle   independence   and   correction   to   a   satisfactory   level   (20/40  or  better).

Conclusion
Presbyopic treatment options are scarce in keratoconus patients, multifocal toric IOLs could be useful in well selected cases.