Intraocular lens power overestimation in a patient with history of circling keratorraphy

We report a case of cataract extraction and intraocular lens (IOL) power overestimation in a patient with history of hyperopia managed with circling keratorraphy. A 65-year-old female presented to our institute complaining of decreased vision in both eyes. The patient had a history of bilateral hyperopia that was managed 20 years ago (1994) with circling keratorraphy. At presentation her uncorrected distance visual acuity (UDVA) was 20/70 and 20/60 in her right eye (OD) and left eye (OS), respectively, while her corrected distance visual acuity (CDVA) was 20/25 OD and 20/25 OS with manifest refraction of −0.50 + 1.50 × 75 OD and +0.50sph + 1.50cyl × 30 OS. Slit lamp examination revealed the presence of a circular intrastromal corneal suture (6 mm diameter) and mild (+1) nuclear sclerosis in both eyes. The patient was scheduled to undergo cataract extraction targeting plano, using a toric IOL; one month after the surgery, the manifest refraction of the operated right eye was −2.00 + 0.50 × 175, reflecting an overestimation of the intraocular lens (IOL) power for the attempted target. Cataract extraction in patients with history of circling keratorraphy for the management of hyperopia results in IOL power overestimation, consistent with that which is seen in patients with other previous hyperopic corneal refractive procedures.