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Ophthalmology
Phakic corneal decompensation with cataract after bioptics: management challenges
  1. Vaibhav Namdev1,
  2. Manpreet Kaur1,
  3. Manvi Bansal1 and
  4. Jeewan S Titiyal2
  1. 1Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
  2. 2Ophthalmology, Dr RP Centre, AIIMS, New Delhi, India
  1. Correspondence to Dr Manpreet Kaur; manpreet.aiims{at}gmail.com

Abstract

A woman in her early 50s presented with diminution of vision, photophobia, pain and watering in right eye for 8 months. She had previously undergone radial keratotomy (RK) in the right eye, followed by bilateral angle-supported phakic intraocular lens (pIOL) implantation. On examination, 16 RK incisions were present in the right eye, with corneal decompensation, rigid angle-supported pIOL in situ, senile cataract and uncorrected distance visual acuity (UDVA) of counting fingers. Three major challenges were accurate biometry, incision management during phacoemulsification with rigid pIOL in situ and keratoplasty in the presence of RK incisions. Swept source optical coherence tomography-based optical biometer and Barrett Universal II formula were used for intraocular lens (IOL) power calculation. First-stage phacoemulsification was performed with pIOL in situ, followed by IOL implantation and pIOL explant via the same incision. Second-stage Descemet stripping automated endothelial keratoplasty (DSAEK) was performed after 1 week; DSAEK prevented splicing of RK incisions. Postoperative UDVA was 20/200, improving to 20/60 with semiscleral contact lens.

  • Anterior chamber
  • Ophthalmology

https://doi.org/10.1136/bcr-2024-261544

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    Footnotes

    • X @Vbhvnamdev210

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MK, VN, MB, JST. The following authors gave final approval of the manuscript: MK, VN, MB, JST. MK is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer-reviewed.