Radial keratotomy: background and how to manage these patients nowadays.

In this review, we presented the principles of radial keratotomy (RK), its evolution, enhancement, and complications, and strategies to manage the consequences of RK in the present day. It is essential to understand the RK procedure f, the theoretical background that supported this surgery, the current effect on the cornea, and how to approach patients needing vision improvement. These patients are developing cataracts that need to be handled well, from the IOL calculation to the surgical procedure. Guided keratorefractive surgery is the most accurate procedure to improve these patient's vision and life. Nevertheless, some patients may need other approaches, such as sutures, penetrating keratoplasty, corneal rings, and pinhole implants, depending on the degree of irregularity of the cornea, ablation depth for guided surgery or if the sutures are open.

Rare case of corneal keloid following radial keratotomy for myopia.

An adult male in his 50s presented with complaints of glare and gradual, painless, progressive diminution of vision in the right eye (RE). Visual acuity in RE was noted to be 2/60, and slit lamp biomicroscopy revealed a pearly grey-white elevated corneal opacity measuring 4 mm × 3 mm, obscuring the visual axis. There was no history of ocular trauma or infection. The patient had undergone bilateral radial keratotomy for myopia correction 25 years ago. Anterior segment optical coherence tomography imaging demonstrated increased corneal thickness of 1080 µm at the site of lesion and the height of the epicorneal mass was noted to be 493 µm. The patient underwent fibrin glue-aided anterior lamellar keratoplasty. Histopathological examination of the excised host tissue confirmed the diagnosis of corneal keloid.

Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy.

A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?

Ray tracing biometry in post radial keratotomy eye.

OBJECTIVE: To report a case of post radial keratotomy (RK) cataract in a 55-year-old lady wherein biometry was done by ray-tracing method incorporated in scheimpflug topographer (Sirius + Scheimpflug Analyzer, CSO, Italy). METHOD: In our case, we performed intraocular lens (IOL) power calculation using a recent concept of ray tracing with scheimpflug topographer and compared with traditional methods available at American Society of Cataract and Refractive Surgery(ASCRS) website (www.ascrs.org) for eyes with prior RK. Phacoemulsification was performed and a monofocal + 24.5D IOL implanted in the capsular bag. RESULT: Manifest refraction at six weeks postoperative period was + 1.0DS/-2.0DC × 75° with spherical equivalence of 0. On comparison of all the methods used to calculate IOL power, the absolute errors of ray tracing and Barrett true K were found to be the least, 0.14 and 0.18 respectively. CONCLUSION: Ray tracing biometry with scheimpflug topographer seems to provide accurate IOL power in post RK eyes.

Late Spontaneous Postradial Keratotomy Corneal Perforation After Scleral Contact Lens Use-Case Report.

PURPOSE: To describe a case of late spontaneous postradial keratotomy corneal perforation after scleral contact lens (SCL) wear for optic correction. SETTING: Tertiary referral center for corneal pathology. DESIGN: Case report. RESULTS: A 64-year-old man presented the consequences of a late radial keratotomy (RK) surgery performed for myopia correction 26 years ago. His ophthalmologic history was a RK in both eyes (BE), previous Lasik surgery in BE and Lasik enhancement in the right eye (RE), and pterygium excision with conjunctival transplantation in RE. To improve visual acuity, SCL were fitted in both eyes. After 8 months of use, on a certain day, when removing the lens from the RE, the patient reported experiencing intense eye pain and reduced visual acuity. On ophthalmologic examination, the RE cornea was perforated in one of the previous RK incisions. An urgent corneal transplant was performed in the RE, followed by cataract surgery in the same eye. CONCLUSION: Corneal instability caused by RK scars and daily manipulation with the SCL use may have led to ocular perforation.

Cataract Surgery after Radial Keratotomy with Non-Diffractive Extended Depth of Focus Lens Implantation.

Radial keratotomy was a popular surgical procedure used to treat myopia. Patients who underwent radial keratotomy several years ago, are currently reporting to the ophthalmologist due to worsening of vision associated with age-related cataracts. In this case report we present a case of a 60-year-old woman who underwent radial keratotomy with 16 incisions in the right eye and 12 incisions in the left eye. The patient reported to an ophthalmologist due to a deterioration of vision caused by a cataract. We described, in detail, the difficulties encountered during the diagnostic procedures, differences in the calculation of intraocular lens, and intraoperative difficulties as compared to patients who had not undergone radial keratotomy. We also present the obtained postoperative results.

Tuck-in deep anterior lamellar keratoplasty for the management of post-radial keratotomy keratectasia.

PURPOSE: To evaluate the outcomes of tuck-in deep anterior lamellar keratoplasty (DALK) for the management of post-radial keratotomy (RK) keratectasia. SETTING: Institution. DESIGN: Retrospective. METHODS: Medical records of all cases presenting with post-RK keratectasia from January 2012 to December 2019 were included. Data on corrected distance visual acuity (CDVA), refraction, keratometry, ultrasonic pachymetry, corneal topography, endothelial cell count, applanation tonometry, and dilated fundus examination recorded at all follow-up visits were included. Details of surgical steps, including intraoperative and postoperative complications and any secondary procedures performed subsequently, were also recorded. RESULTS: 7 eyes of 5 patients that developed corneal ectasia after a previous RK procedure underwent DALK with peripheral tuck-in. All eyes had CDVA ≤6/24, preoperatively. The surgical procedure was successfully performed in all eyes without any intraoperative complications. CDVA at the final follow-up ranged between 6/9 and 6/60, with 6 eyes achieving CDVA of 6/18 or better. The median keratometric cylinder reduced from a preoperative value of 7.2 ± 9.27 diopters (D) to 2 ± 1.83 D at the final follow-up. The median central corneal thickness at the final follow-up was 598 ± 40.01 µm, and spherical equivalent ranged between -1.75 D and -3.5 D (median -2 ± 0.57). The percentage of endothelial cell loss ranged between 2.1% and 8.4%. All eyes retained graft clarity, and none showed any evidence of significant interface haze or corneal vascularization. CONCLUSIONS: Tuck-in DALK could successfully address corneal ectasia developing after RK, achieving visual gains. Moreover, it was able to restore the peripheral corneal thickness with a minimal risk for dehiscence of RK incisions.

Descemet membrane endothelial keratoplasty in a patient with iris-fixated intraocular lens and prior radial keratotomy: a case report.

BACKGROUND: Anterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation. CASE PRESENTATION: A 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery. CONCLUSION: To our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL.

Scleral Lens-Induced Corneal Edema After Radial Keratotomy.

ABSTRACT: This case series examines the magnitude and regional variation in scleral lens-induced corneal edema in postradial keratotomy (RK) eyes. Scheimpflug imaging was used to measure corneal thickness across the central 6 mm before and after scleral lens wear in nine post-RK eyes (median age 64 years). Variations in corneal edema were examined as a function of distance from the corneal center (six 0.5-mm annuli) and from 0° to 360°. The median central corneal edema was 2.19% (interquartile range 1.03%-3.18%; P=0.02) and increased in magnitude and variability further from the central cornea (from 1.30% in the central 0-0.5 mm to 3.12% in the 2.5-3.0 mm midperiphery) (P=0.02). Scleral lens-induced corneal edema in post-RK eyes was greater in magnitude further from the corneal center and at the approximate location of corneal incisions.

[Radial keratotomy: history and current state]. / Radial'naya keratotomiya: istoriya i real'nost'.

Results of clinical use of the radial keratotomy (RK) surgery are presented in the format of a lecture and a summary. The analysis encompasses the mechanism of changes in corneal refraction, immediate intra- and postoperative complications, so-called secondary symptoms and long-term effects (addition of various pathological processes, influence of corneal changes on the results of diagnostic tests and treatment methods) of the surgery.

Bowman Layer Onlay Graft for Reducing Fluctuation in Visual Acuity After Previous Radial Keratotomy.

PURPOSE: To describe the clinical outcome of a first patient undergoing Bowman layer (BL) transplantation with an onlay graft to reduce fluctuation in visual acuity and refractive error after previous radial keratotomy (RK) surgery. METHODS: In 2018, a 66-year-old woman presented with complaints of long-standing diurnal fluctuation in best-spectacle corrected visual acuity (BSCVA) after RK in 1983. After the removal of host epithelium, a BL graft was positioned onto the host cornea. BSCVA, Scheimpflug-based corneal tomography, and anterior segment optical coherence tomography were evaluated up to 12 months postoperatively. RESULTS: The surgery and postoperative course were uneventful. After surgery, the subjective complaints of visual fluctuation were reduced from 10 to 3 on a scale from 1 to 10. BSCVA (20/40; 0.5) did not change from preoperative to postoperative. Corneal tomography showed an overall central corneal steepening of 5.9 diopters. Biomicroscopy, Scheimpflug imaging, and anterior segment optical coherence tomography showed a completely epithelialized and well-integrated graft, with some minor epithelial remnants located in the preexisting keratotomy incisions. CONCLUSIONS: BL onlay grafting may have the potential to manage patients with subjective complaints of diurnal fluctuation in visual acuity after previous RK.

Queratitis infecciosa tardía en paciente con queratotomía radial y síndrome del párpado flácido tratado con puntos sueltos / Delayed infectious keratitis in a patient with radial keratotomy and floppy eyelid syndrome treated with simple interrupted stitches

Un varón de 55 años acudió a nuestro centro con una queratitis infecciosa en el ojo izquierdo afectando a una de las incisiones de una queratotomía radial que se había realizado 34 años antes. La colocación de dos puntos sueltos en dicha incisión fue clave para la resolución de la infección. Este paciente también fue diagnosticado de síndrome del párpado flácido. ¿Puede esto actuar como factor de riesgo para la queratitis infecciosa en pacientes que se han realizado una queratotomía radial? La asociación entre ambas entidades no ha sido descrita con anterioridad y además este caso representa el segundo en el que se describe el uso de puntos sueltos como tratamiento coadyuvante en este tipo de casuística

A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases

Delayed infectious keratitis in a patient with radial keratotomy and floppy eyelid syndrome treated with simple interrupted stitches. / Queratitis infecciosa tardía en paciente con queratotomía radial y síndrome del párpado flácido tratado con puntos sueltos.

A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases.

Non-Descemet stripping automated endothelial keratoplasty for post radial keratotomy corneal edema.

An elderly male with monocular status presented with complaints of gradual loss of vision in his left eye. Slit-lamp evaluation revealed postradial keratotomy (RK) corneal decompensation. He underwent non-Descemet stripping automated endothelial keratoplasty (nDSAEK) in his left eye. Postoperatively, his visual acuity improved from counting finger at 1 m to 20/200, J5. Graft adherence was good. A preexisting epiretinal membrane with macular edema was noted, but our patient refused any further surgical intervention for the same. In conclusion, nDSAEK may be considered as an effective treatment modality for the management of post-RK corneal decompensation.

A Case of Late Spontaneous Post-Radial Keratotomy Corneal Perforation Managed With Specialty Lenses.

PURPOSE: To describe a case of spontaneous wound dehiscence 29 years after radial keratotomy (RK) and to illustrate how specialty contact lenses were used for tectonic support and optic correction. SETTING: Tertiary referral center for corneal pathology. DESIGN: Case report. RESULTS: In November 2014, a 62-year-old woman presented to the emergency department with a spontaneous corneal perforation in her left eye. Her ocular history was significant only for uncomplicated RK surgery performed in 1985 to correct myopia (-5.50 D) in both eyes. At the slit-lamp pronounced, bullous edema was seen in the inferotemporal quadrant of the left cornea with internal opening of the 3.30- and 5-o'clock positions incisions and severe localized thinning and aqueous leakage at the 5-o'clock position incision. There was no history of trauma. A conservative approach was adopted: application of a standard bandage lens was effective in tamponading the leakage, allowing the anterior chamber to reform; a custom-made soft lens was worn for tectonic support over a period of 4 months. Finally, visual acuity was restored to 20/20-by fitting a scleral lens. CONCLUSION: Spontaneous corneal perforation is a rare but more dramatic long-term complication after RK. The pivotal role of appropriately fitted soft bandage lenses in the conservative management of this type of complex perforation is highlighted. For optical correction, a scleral lens was fitted with excellent visual result, illustrating the added value of specialty contact lenses as an alternative to surgery in the management of postrefractive corneas.