J Korean Ophthalmol Soc.  2016 Feb;57(2):310-315. 10.3341/jkos.2016.57.2.310.

A Case of Cataract Surgery in an Epikeratophakia Patient

• Jeon SJ
• Cho YK

• KMID: 2213674
• DOI: http://doi.org/10.3341/jkos.2016.57.2.310

Abstract

PURPOSE
To report a case of cataract surgery in an epikeratophakia patient.
CASE SUMMARY
A 59-year-old female with a history of epikeratophakic surgery 20 years ago complained of decreased visual acuity of both eyes for several months. She had nucleosclerotic and posterior subcapsular types of cataracts. Phacoemulsification and posterior capsule intraocular lens implantation were performed in both eyes. During surgery, corneal edema was especially prominent at the cornea with epikeratophakic lenticules in both eyes. In the left eye, severe corneal edema after one day of surgery was observed; however, after one week, corneal edema had subsided and visual acuity of both eyes had improved.
CONCLUSIONS
When it necessary that cataract surgery is performed in patients with epikeratophakic lenticules, it is important to anticipate the corneal edema intraoperatively and postoperatively. Moreover, the surgeon should consider the acute calculation of the target refraction of intraocular lens in an epikeratophakia patient.

Keyword

Cataract surgery; Corneal edema; Epikeratophakia

MeSH Terms

Cataract*
Cornea
Corneal Edema
Epikeratophakia*
Female
Humans
Lens Implantation, Intraocular
Lenses, Intraocular
Middle Aged
Phacoemulsification
Visual Acuity

Figure

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  Figure 1. Pentacam® examination of both eyes before cataract surgery. (A) Right eye: Pentacam® shows a flattened curvature of the right cornea due to epikeratophakic lenticule. The location of epikeratophakic lenticule is slightly nasal to the center of the cornea and the keratometric value (true net power) at the center of the right cornea is 31.1 diopter. (B) Left eye: Pentacam® shows a flattened curvature of the left cornea due to epikeratophakic lenticule. The location of epikeratophakic lenticule is slightly nasal to the center of the cornea and the keratometric value (true net power) at the center of the left cornea is 36.2 diopter.

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  Figure 2. Intraoperative microscopic view of the both eyes during cataract surgery. (A) Right eye. (B) Left eye. (A-1, B-1) Immediately before corneal incision: the white arrows indicate 12 o'clock position of the cornea at the intraoperative microscopic view. In each right and left eye, the epikeratophakic lenticule is located slightly nasal to the center of the cornea. (A-2, B-2) Immediately after hydrodissection: the margin of the epikeratophakic lenticule caused blurring of the image due to scattering of light, thus made it difficult to distinguish the capsulorrhexis margin before and after hydrodissection. (A-3, B-3) During phacoe-mulsificaiton: the corneal edema increased during phacoemulsification, in which the surgeon needed to decrease the illumination of the operating room to improve the microscopic view. (A-4, B-4) At the end of operation.

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  Figure 3. Pentacam® Scheimpflug images of both eyes. (A) Right eye. (B) Left eye. (A-1, B-1) Preoperative images: the epikeratophakic lenticules are well attached to the corneal stroma in both eyes. (A-2, B-2) Postoperative 1 day: (A-2) In the right eye, there is mild corneal edema in both epikeratophakic lenticule and stromal bed. (B-2) In left eye, there was severe corneal edema in both epikeratophakic lenticule and stromal bed. (A-3, B-3) Postoperative 1 week: the corneal edema subsided in both eyes.

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