At the ESCRS 2025 Congress in Copenhagen, YouMed interviewed Dr. Emilio A. Torres-Netto, MD, PhD, FEBO, FWCRS on new strategies for managing patients who present with both cataract and keratoconus. This dual diagnosis presents a particular surgical challenge: the irregular cornea caused by keratoconus complicates biometry and intraocular lens (IOL) selection, while the presence of cataract further reduces visual quality.
Dr. Torres-Netto emphasized that the cornea’s condition is central to surgical planning. In highly irregular corneas, a staged approach can improve outcomes: the cornea is first optimized and regularized using an individualized cross-linking protocol before proceeding to cataract surgery. This strategy stabilizes the cornea and makes measurements for IOL implantation more reliable.
Traditionally, cross-linking has been used to halt progression in keratoconus. The innovative development presented at ESCRS 2025 is the use of individualized, topography-guided cross-linking (ELZA-PACE) not only to stabilize but also to regularize the corneal shape—even in eyes with stable keratoconus. By selectively flattening the steepest corneal regions while inducing steepening in flatter areas, this approach achieves a more regular optical surface. The improved corneal profile facilitates more precise cataract surgery planning and enhances postoperative visual outcomes.
In cases with only mild irregularity, the sequence may be reversed: cataract surgery can be performed first, followed by corneal optimization if required. When irregularity is severe, however, cross-linking is performed first to create a more predictable environment for lens surgery.
Dr. Torres-Netto also highlighted additional options for corneal rehabilitation, such as intracorneal ring segments (including Femto- and ECO-CAIRS) and combined excimer laser procedures (e.g., wavefront-guided PRK with cross-linking). These interventions can be tailored according to the patient’s corneal profile and disease stage, further underscoring the need for individualized treatment.
The key message from the interview is clear: successful management of patients with both cataract and keratoconus depends on precise diagnosis, careful staging, and a stepwise surgical plan. By first improving and stabilizing the cornea where necessary, ophthalmologists can achieve more predictable cataract surgery and deliver better visual results.
With individualized cross-linking protocols such as ELZA-PACE, surgeons now have new tools to regularize corneal shape and expand treatment options for this complex patient group.
