Difficulty of biometric images and calculation of intraocular lens in a patient with Sjogren's syndrome

Abstract

Aims/Purpose: To report a patient with a history of Sjogren's Syndrome and several ocular surface compromise with mature cataracts and difficult intraocular lens calculation.Methods: Case report and literature review.Results: A 75‐year‐old woman with a history of primary Sjogren's syndrome for almost 10 years with a long‐standing picture of foreign body sensation in both eyes, ocular burning, red eye and marked photophobia that was not improving despite several topical managements, currently with punctal plugs and using 0.5% carboxymethylcellulose, 0.4% sodium hyaluronate preservative free and ciclosporin emulsion 0.05%. Different topical treatments were used with any recovery on her ocular surface and the patient started developing dense cataracts in both eyes with important visual loss. The biometries performed were unreliable despite taking different images because of the great difficulty to get reproducibility on the keratometry measurements and for this reason it was not possible to predict the power of the lens to be implanted, we decided to try an aphakic refraction and multiply it by a conversion factor to get the power of the lens that was described long time ago in the literature. One month post‐op, the patient had a refraction of −1.50 −1.50 × 168° (0.3 LogMAR, J1) in the left eye and −0.50 −0.25 × 145° (0.3 LogMAR, J2) in the right eye.Conclusions: We have a great limitation of information to calculate intraocular lenses in those patients who, for different reasons and despite very complete treatments, cannot reach an optimal ocular surface. There is currently no consensus on IOL calculations in severe ocular surface diseases.