Corneal Transplant

"If I caused just one injury to a cornea that resulted in a loss of vision with a contact lens that even remotely resembled the damage from an RK operation I would lose my license to practice immediately."

Keith Harrison, FCLSA, NCLE-AC as spoken to RKsurvivor.

"Patients may require further ocular surgery sometime during their life after radial keratotomy, and the presence of the weakened keratotomy scars may make the subsequent surgical procedure and postoperative course more difficult. For example, penetrating keratoplasty (corneal transplant) done within a few years after radial keratotomy often produces opening of the scars during trephination."

Statement on Radial Keratotomy, George O Waring III - 1988


Penetrating keratoplasty after radial keratotomy. A report of six patients

 Background

For more than 15 years, radial keratotomy has increased in popularity as an option for treating myopia in the United States. During this period of time, the procedure has been modified to improve results and decrease complications. Despite these changes, complications from radial keratotomy continue to occur. The authors report six cases of penetrating keratoplasty performed to correct significant loss of vision resulting from complications of radial keratotomy.

Methods

The surgical records of one author (WR) were reviewed retrospectively for penetrating keratoplasties performed for complications of radial keratotomy.

Results

Six cases of penetrating keratoplasty performed for complications of radial keratotomy were found. Severe loss of vision was the indication for surgery in each case, and was associated with aggressive and repeated incisional refractive attempts to correct astigmatism, hyperopic overcorrection, residual myopia, or refractive errors associated with keratoconus. Glare associated with subepithelial scarring and irregular astigmatism were the primary findings associated with loss of vision.

Conclusions

Despite advances in technique and instrumentation, radial keratotomy is limited in the amount of myopia it can correct. The risk for loss of vision increases with increasing number of incisions, intersecting incisions, very small optical zones, and keratoconus.


Penetrating Keratoplasty for Severe Complications of Radial Keratotomy

Hersh, Peter S. M.D.; Kalevar, V M.D.; Kenyon, Kenneth R. M.D.

Abstract

Severe sight-threatening complications were seen in five eyes of three patients following improperly performed radial keratotomy. All patients exhibited neovascularization of the incision sites, severe stromal scarring or ulceration involving the visual axis, loss of the anterior chamber, and iridocorneal adhesions. These complications necessitated multiple and complex surgical interventions, including penetrating keratoplasty and anterior segment reconstruction. Final visual acuity was decreased to light perception in four eyes while one eye achieved 6/60 vision following repeated penetrating keratoplasty. The success and safety of radial keratotomy rely on careful case selection, appropriate instrumentation, specialized training, and the ability to perform complex secondary procedures to correct surgical complications.

(C) Lippincott-Raven Publishers.