ABSTRACT
The use of incisional refractive surgery has become limited due to the widespread use of the excimer laser to correct myopia, hyperopia and astigmatism. Laser in situ keratomileusis and photorefractive keratectomy have proven to be much more accurate and predictable in correcting refractive error. This has made some forms of incisional refractive surgery practically obsolete. Radial keratotomy should not be considered a primary refractive procedure in the modern world, as RK has become "RKhaic". There are still indications for incisional refractive surgery in cataract and post-surgical patients for the treatment of astigmatism. However, with the advent of the toric intraocular lens and the use of LASIK in such aforementioned patients, these indications for incisional surgery will likely become more limited. In this review, we go over the past history of incisional refractive surgery and also report the current uses and advancements of this technique in today's practice environment.
Subject(s)
Keratomileusis, Laser In Situ , Keratotomy, Radial , Refractive Surgical Procedures , Astigmatism/surgery , History, 19th Century , History, 20th Century , Humans , Keratomileusis, Laser In Situ/history , Keratomileusis, Laser In Situ/methods , Keratotomy, Radial/history , Keratotomy, Radial/methods , Refractive Errors/historyABSTRACT
This set of "Viewpoints" articles examines the relative merits of radial keratotomy (RK), photorefractive keratectomy (PRK), and laser assisted in-situ keratomileusis (LASIK). Drs. Rowsey and Morley review advances in RK techniques, long-term results, and complications, and explain why RK will remain a viable method for correction of moderate myopia, notably its minimal cost. Drs. Steinert and Bafna review both PRK and LASIK, discussing techniques and results and comparing their advantages and disadvantages with each other and with RK. Dr. Dutton, as "Viewpoints" section editor, summarizes clinical, technologic, and economic aspects of all three techniques, concluding that all will find a place among refractive surgeons for some time to come.
Subject(s)
Cornea/surgery , Keratotomy, Radial/methods , Myopia/surgery , History, 19th Century , History, 20th Century , Humans , Keratotomy, Radial/adverse effects , Keratotomy, Radial/economics , Keratotomy, Radial/history , Patient Selection , Refraction, OcularSubject(s)
Keratotomy, Radial/history , Ophthalmology/history , Cornea/surgery , History, 20th Century , PoliticsSubject(s)
Ophthalmology/history , Politics , History, 20th Century , Keratotomy, Radial/history , RussiaABSTRACT
There was a lack of consensus among DATTA panelists about the safety and, especially, the effectiveness of radial keratotomy. For patients with a preoperative refractive error greater than -6.00 D, DATTA panelists believed that radial keratotomy has not been established as safe or effective. Concerns about effectiveness focused on the lack of predictability of the results and the continuing change in the refractive error following surgery. Daily fluctuations in visual acuity and the occurrence of anisometropia were other reported adverse events that contributed to the concern expressed by DATTA panelists. Concern over the safety and effectiveness of the procedure became greater as the magnitude of the preoperative refractive error increased. Nevertheless, there is a subpopulation of myopic patients who regard their myopia as a sufficiently severe handicap for them to undergo radial keratotomy. Such carefully chosen patients who have the procedure performed may achieve emmetropia and be free of corrective lenses.
