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J Madani-Becker, JD Primack, J Luchs, S Mandelbaum, IJ Udell; Abnormal Postoperative Vision Following Cataract Surgery due to Previously Undetected Atypical Keratoconus . Invest. Ophthalmol. Vis. Sci. 2002;43(13):384.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To report 4 cases of patients who underwent uncomplicated cataract surgery with resulting sub-optimal best spectacle corrected visual acuity (BSCVA) found on further investigation to have topographic evidence of keratoconus. Methods:We reviewed charts of patients referred for abnormal post-operative vision and refraction following uneventful cataract extraction. Pertinent data included age, sex, post-operative BSCVA, keratometry, slit lamp examination findings, and corneal videokeratography. Results:Four eyes of three patients referred for unsatisfactory vision after uncomplicated cataract surgery had corneal topography findings consistent with the diagnosis of keratoconus. Two patients were females. One patient was male. Mean age was 73.67 years (range, 72 - 76). Three eyes underwent uncomplicated phacoemulsification and 1 eye extracapsular cataract extraction. BSCVA ranged from 20/30 to 20/40-2. Mean diopters (D) of astigmatism (available for 3 of 4 eyes) by keratometry measured 2.08 D (range, 0.5 - 3.0 D). Mean keratometry (available for 3 of 4 eyes) measured 44.33 D (range, 41.50 - 46.00 D). Pertinent slit lamp examination findings included only an abnormal red reflex in one patient. Well-centered posterior chamber intraocular lenses were present in all eyes with clear posterior capsules, except for one patient with mild capsular haze. No corneal thinning, abnormal iron lines, or Vogt’s striae were observed. Videokeratography revealed corneal steepening superotemporally in 1 eye, temporally in 1 eye and inferiorly in 2 eyes. Conclusion: The 4 pseudophakic eyes exhibited minimal slit lamp examination findings, keratometry values of 46.00 D or less, and mild astigmatism yet were found to have evidence of abnormal corneal topography, possibly consistent with atypical keratoconus. Clinicians should consider a diagnosis of keratoconus in their differential diagnosis when evaluating patients with unexplained, sub-optimal BSCVA following uncomplicated cataract surgery.
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