Skip to main content Skip to main navigation menu Skip to site footer

Refractive lens exchange on keratoconus patient: a case report


Introduction. Keratoconus is a vision disorder that occurs when the cornea becomes thin and irregularly (cone) shaped. Instead of being focused correctly on the retina, this abnormal shape causes the light entering the eye to improperly refracted and manifested as a distortion of vision. Refractive Lens Exchange is one type of Invasive therapy in Keratoconus. Here we describe a case of Keratoconus managed by the Refractive Lens Exchange procedure in our Center.

Case Description. A male, 25 years old, visited the clinic due to blurry vision since ten years ago. Every six months or a year, he needs to adjust his lens power. Ophthalmology examination found visual acuity in the right eye was 2/60 PH 6/60, and if using S-9.00, visual acuity improved to 6/30. Meanwhile, visual acuity in the left eye was 1/60 PH 6/60 and if using S–11.75, visual acuity improved to 6/48. Corneal topography supports the finding of Keratoconus. Management for this patient was Refractive Lens Exchange + Intraocular Lens + Capsular Tension Ring. Initially, This  advised was differ from the patient expectation, as he wanted a LASIK procedure. An important reminder was given, that Keratoconus is contraindicated for LASIK and any corneal surface ablation procedure. After series of procedure, the VA of the right eye was 6/15 PH 6/6, with C - 4.00 x 1800 VA became 6/6. VA left eye was 6/18 PH 6/9, with C - 4,00 x 1800 VA became 6/9. Binocular vision was 6/6. For near vision, S +3.00 was added for both eyes.

Conclusions. Refractive Lens Exchange + Intraocular lens implantation is effective and safe procedures to treat high myopia in keratoconus cornea.


  1. American Academy of Ophtalmology. Corneal Dystrophies and Ectasias. In: BCSC External Disease and Cornea - Section 8. San Fransisco: AAO; p. 161–8.
  2. Andreanos KD, Hashemi K, Petrelli M, Droutsas K, Georgalas I, Kymionis GD. Keratoconus Treatment Algorithm. Ophthalmol Ther. 2017;6(2):245–62.
  3. Romero-Jiménez M, Santodomingo-Rubido J, Wolffsohn JS. Keratoconus: A review. Contact Lens Anterior Eye. 2010;33(4):157–66.
  4. American Academy of Ophtalmology. The Science of Refractive Surgery. In: BCSC Refractive Surgery. San Fransisco: AAO; p. 29–36. (2019-2020).
  5. Anderson D. Understanding Corneal Topography [Internet]. AOA; 2017. Available from:
  6. Martin R. Cornea and anterior eye assessment with placido-disc keratoscopy, slit scanning evaluation topography and scheimpflug imaging tomography. Indian J Ophthalmol. 2018;66(3):360–6.
  7. Naderan M, Jahanrad A, Farjadnia M. Clinical biomicroscopy and retinoscopy findings of keratoconus in a Middle Eastern population. Clin Exp Optom. 2017;101(1):46–51.
  8. Denny P. Keratoconus: New Consensus, New Goals - American Academy of Ophthalmology [Internet]. Available from:
  9. Alió JL, Grzybowski A, Romaniuk D. Refractive lens exchange in modern practice: when and when not to do it? Eye Vis Lond Engl. 2014;1:10–10.
  10. Refractive Lens Exchange (Clear Lens Extraction) for Myopia Correction: Background, History of the Procedure, Problem [Internet]. Available from:
  11. Srinivasan B, Leung HY, Cao H, Liu S, Chen L, Fan AH. Modern Phacoemulsification and Intraocular Lens Implantation (Refractive Lens Exchange) Is Safe and Effective in Treating High Myopia. Asia-Pac J Ophthalmol Phila Pa. 2016;5(6):438–44.
  12. Horgan N, Condon PI, Beatty S. Refractive lens exchange in high myopia: long term follow up. Br J Ophthalmol. 2005;89(6):670–2.

How to Cite

Buddyman, I. J., Pemayun, C. I. D., & Handayani, A. T. (2021). Refractive lens exchange on keratoconus patient: a case report. Intisari Sains Medis, 12(1), 290–293.




Search Panel

Ivane Jessica Buddyman
Google Scholar
ISM Journal

Cokorda Istri Dewiyani Pemayun
Google Scholar
ISM Journal

Ariesanti Tri Handayani
Google Scholar
ISM Journal