Bilateral microcornea and unilateral macrophthalmia resulting in incorrectintraocular lens selection

A 79-year-old man with symmetrical microcornea and a dense unilateral nucle ar sclerotic cataract had cataract extraction by phacoemulsification. The S RK/T formula suggested a 10.0 diopter (D) intraocular lens (IOL) for emmetr opia (axial length 26.58 mm). The noncataract eye required a 25.0 D IOL for emmetropia (axial length 21.51 mm). Biometric measurements were rechecked, and an 18.0 D IOL was implanted (axial length 24.02 mm). The 6 week postop erative refraction of -13.0 +2.0 x 25 necessitated IOL exchange (10.0 D). S ix weeks postexchange, the refraction was -3.75 +2.5 x 30. This illustrates that symmetrical anterior microphthalmos does not always coexist with symm etrical posterior microphthalmos. Awareness of the association of symmetric al microcornea and unilateral colobomatous macrophthalmia may aid appropria te IOL selection in future cases. J Cataract Refract Surg 1999; 25: 1016-10 18 (C) 1999 ASCRS and ESCRS.