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Combined surgical and contact lens strategy improves vision in advanced keratoconus

Optometry 360

Key Takeaways

  1. After staged treatment and semi-scleral lens fitting, corrected visual acuity reached 0.4 in the right eye and 0.7 in the left eye.
  2. Cataract surgery followed by corneal ring implantation and contact lens fitting improved corneal regularity, visual quality, and reported daily functioning.

A staged combination of cataract surgery, intrastromal corneal ring segment implantation, and semi-scleral rigid gas-permeable contact lenses provided meaningful visual rehabilitation in a highly myopic patient with advanced keratoconus, bilateral cataracts, and severe baseline visual impairment, according to a case report presented at the 44th Congress of the European Society of Cataract and Refractive Surgeons.

The patient had progressive bilateral visual loss, with uncorrected visual acuity limited to hand movements. Subjective refraction reached only 0.05 decimal acuity with −30.00 D in the right eye and −23.00 D in the left eye, and rigid gas-permeable lenses improved acuity to 0.2 and 0.1, respectively. Examination showed marked inferior corneal thinning and bilateral corticonuclear cataracts.

Management was performed sequentially, beginning with bilateral phacoemulsification with planned aphakia, followed by intrastromal corneal ring segment implantation. The ring segments improved corneal regularity and enabled more reliable refractive assessment. After refractive stabilization, the patient was fitted with 12.70-mm semi-scleral rigid gas-permeable lenses.

Corrected visual acuity subsequently improved to 0.4 in the right eye and 0.7 in the left eye. The patient also reported substantial improvements in visual quality and daily functioning compared with the preoperative condition.

The authors suggested that a tailored, multidisciplinary strategy may provide functional visual rehabilitation in selected patients with advanced keratoconus, cataract, and other ocular comorbidities.

Reference

Cabanás Jiménez M, et al. Comprehensive Visual Rehabilitation In A Patient With Advanced Keratoconus And Cataract: Combined Surgical And Optometric Management. Presented at: ESCRS 2026 Congress; September 11-15, 2026; London, England.

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