This is a tough case in a patient with just one eye. He had a prior history of 16-cut radial keratotomy (RK) done to both eyes 30 years ago for the treatment of myopia. He has since developed a cataract in his remaining eye, having lost the vision in the other eye to phthisis bulbi. He presents to our clinic for cataract surgery. The RK has continued to flatten his cornea and his adjusted IOL calculations determine that a +28.5 D IOL will give a post-op result of close to plano. He also has 2 diopters of regular corneal astigmatism which will necessitate the use of a toric IOL.
The cataract surgery is performed through a scleral tunnel since we do not want to touch his delicate cornea and we do not want our phaco incision to intersect any of the old RK incisions. The cataract surgery goes beautifully and the post-op vision is excellent. However, he develops a dellen and corneal thinning by the post-op day 7 visit. My judgment was to take him back to the operating room to perform a conjunctivoplasty to protect the cornea and allow it to heal. Fortunately, he has done very well. This is a tough case that taught me the importance of vigilance and judgment, especially in a monocular patient.