Cataract Surgery in Keratoconus

Cataract surgery in keratoconus is not routine surgery. It is challenging in many ways and requires and extraordinary amount of experience, high-tech equipment and thorough planning.

No routine surgery

To perform cataract surgery in eyes with keratoconus (or in any eye) surgeons need to measure the anatomical characteristics of the eye in a process called optical biometry. This enables the surgeons to calculate how much your eye focuses light onto the retina (your “optical power”) and what contribution your lens makes to the focusing. This enables the surgeon to select the intraocular lens (IOL) with the right “power” for your eye.

Cataract surgery in keratoconus is a challenge for the surgeon

When talking about cataract surgery in keratoconus, it is worth remembering that around 70% of the focusing of light onto the retina is performed by the cornea, with the rest by the lens. As patients with keratoconus have highly irregular corneas, this means that both planning the surgery and choosing the best intraocular lens can be highly challenging.

How we do it

Hitting the Target

At ELZA, we use advanced ocular biometry equipment to perform comprehensive exams that measure the anatomy and optical power of all patients’ corneas. This benefits everyone, not just those with keratoconus.

Everyone undergoes series of examinations with advanced corneal (and retinal) diagnostic equipment, including corneal topography, corneal wavefront analysis, OCT imaging and ocular aberrometry. These are specialised instruments that regular cataract surgeons do not have – but are particularly important to perform in eyes with irregular corneas.

What makes us unique are the following points:

We are the only eye clinic in Switzerland equipped with a combination of some of the most advanced and sophisticated devices to measure corneal biomechanics (CorVis ST), corneal wavefront (Sirius, CSO Italia), ocular aberrometry (Peramis, CSO Italia) and a high-resolution anterior segment OCT, combined with placido-based technology (MS-39, CSO Italia)
Having all these devices is like having a Formula 1 car: it cannot show its full potential without an experienced driver. And this is where our experience in the field of keratoconus and cornea comes really shows its value. This experience is essential because the data from the measurements leaves us with a great range of possible lens powers that could be used. We then have to decide, based on our experience, which lens is the right choice.

Accurate measurements of your ocular anatomy are required to calculate the correct IOL power for your eye

During the procedure

Keratoconic corneas tend to be thinner than normal, but unless they are extremely thin, this should not make a difference to the technical difficulty of the procedure. At ELZA, we can offer the option of femtosecond laser-assisted cataract surgery, where the laser can make super-accurate incisions in the cornea, perform a capsulotomy, and pre-fragment the lens to make the entire procedure as safe and as “light touch” as possible. This approach should be considered in eyes with very thin keratoconus corneas that require cataract surgery.

A femtosecond laser has been used to make a capsulotomy

What to expect after surgery

The intraocular lens will replace your natural lens. So the best this lens can do is to remove the additional blurriness that began with the onset of your cataract.

The new lens can be compared to a fresh pair of glasses. It makes vision better, but neither glasses nor an intraocular lens can correct for the optical errors that have their origins in the irregular keratoconus cornea. Cataract surgery treats the lens, not the cornea. In other words: we return your vision back to the level it was before your cataract started to develop.

At 6 months after your cataract surgery, we can perform additional corneal laser surgery. This approaches the problems of an irregular cornea and can therefore further improve your quality of vision.

Which type of cataract surgery: laser or ultrasound?

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ELZA Dietikon

ELZA HB Zürich

Cataract Surgery in Keratoconus

No routine surgery

Cataract surgery in keratoconus is a challenge for the surgeon

Hitting the Target

What makes us unique are the following points:

During the procedure

What to expect after surgery

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ELZA Zürich HB

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