Zainudin Firdhaus, Gan Yuen Keat, Kamaruddin Haireen, Che Hamzah Jemaima
Department of Ophthalmology, Hospital Selayang, Batu Caves, MYS.
Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Selangor, MYS.
Cureus. 2025 Jun 23;17(6):e86635. doi: 10.7759/cureus.86635. eCollection 2025 Jun.
Keratoconus is one of the most common forms of corneal ectasia. In severe cases, patients experience significant visual impairment, which can be further exacerbated by the development of cataracts. This deterioration may not only impact their vision but also affect their emotional well-being and mental health. Here, we report a case of a patient with severe keratoconus who underwent cataract surgery in both eyes, leading to a remarkable transformation in her life. An 80-year-old woman with underlying hypertension initially presented with bilateral blurring of vision and elevated intraocular pressure (IOP). She was diagnosed with bilateral primary angle closure glaucoma (PACG) and was started on antiglaucoma treatment, with cataract extractions planned. Before surgery, she was semi-dependent and experienced frustration and depression due to her deteriorating vision. The preoperative assessment revealed keratoconus, with cylindrical power of -10.00DC in the right eye and -9.00DC in the left eye. She consented to monofocal toric intraocular lens (IOL) implantation. Postoperatively, her cylindrical power was significantly reduced to -2.50DC in the right eye and -1.50DC in the left eye. Her vision improved markedly despite underlying PACG and tunnel vision. The patient now feels more independent and her quality of life has significantly improved. Careful biometry calculations, thorough planning, and patient counseling are essential for achieving optimal postoperative outcomes in cataract surgery for stable keratoconus patients. This case highlights that significant astigmatism correction due to keratoconus is possible in selected individuals, improving both vision and overall quality of life.
圆锥角膜是角膜扩张最常见的形式之一。在严重的情况下，患者会出现明显的视力损害，而白内障的发展会进一步加剧这种损害。这种恶化不仅可能影响他们的视力，还会影响他们的情绪健康和心理健康。在此，我们报告一例严重圆锥角膜患者双眼接受白内障手术，使其生活发生显著转变的病例。一名患有高血压的80岁女性最初出现双眼视力模糊和眼压升高。她被诊断为双眼原发性闭角型青光眼（PACG），并开始接受抗青光眼治疗，同时计划进行白内障摘除术。手术前，由于视力恶化，她处于半依赖状态，并感到沮丧和抑郁。术前评估显示存在圆锥角膜，右眼柱镜度数为-10.00DC，左眼为-9.00DC。她同意植入单焦点散光人工晶状体（IOL）。术后，她的柱镜度数显著降低，右眼降至-2.50DC，左眼降至-1.50DC。尽管存在原发性闭角型青光眼和管状视野，但她的视力仍有显著改善。患者现在感觉更加独立，生活质量也有了显著提高。对于稳定的圆锥角膜患者，在白内障手术中进行仔细的生物测量计算、全面的规划和患者咨询对于实现最佳术后效果至关重要。该病例表明，在特定个体中，因圆锥角膜导致的显著散光矫正成为可能，从而改善视力和整体生活质量。
