The unmasking of latent dermatochalasis is a potential complication of the use of BTX-A in the treatment of forehead wrinkles. Thorough preoperative assessment of these patients can identify those at risk of this problem and thus reduce the risk of the complication. AcknowledgementsProprietary/Financial interest: None. Patients with previous radial keratotomy (RK) have radial incisions of unknown depth, often extending to the limbus, limiting the space for safe placement of a corneal section for phacoemulsification. We report a case of dehiscence of an RK incision during phacoemulsification. References Case reportAn 85-year-old male with high myopia presented with a best-corrected visual acuity (BCVA) of 6/36 in either eye. Examination revealed bilateral RK with eight incisions in each eye and significant bilateral lens opacity. The RK, performed 14 years earlier, reduced his myopia (spherical equivalent) from À17.00 to À5.50 D in the right eye and À19.50 to À6.00 D in the left eye. Phacoemulsification in the right eye was carried out through a superior clear corneal section. During phacoemulsification one of the RK incisions adjacent to the section started to dehisce resulting in profuse leak and anterior chamber shallowing. A 10/0 nylon suture perpendicular to the RK incision apposed the gape preventing further extension of the dehiscence (Figure 1). Phacoemulsification was completed without further complication with insertion of a foldable silicone intraocular lens (IOL). In the absence of pre-RK refraction or keratometry, we used the standard Holladay formula with axial length measurements from B-scan ultrasound and keratometry from a Nidek handheld keratometer. The IOL selected was predicted to give a À1.67 D postoperative refraction. Postoperative recovery was uneventful and corneal topography was stable at 2 weeks ( Figure 2a) and 10 weeks (Figure 2b) postoperatively. Suture removal was deferred to maintain wound integrity and to limit corneal flattening in the axis of the incision. Myopic degeneration limited the BCVA to 6/12 with a manifest refraction of À0.75 À1.25 Â 131 at 3 months after surgery. Uneventful phacoemulsification was carried out using a superior scleral tunnel for the left eye. Insertion of a foldable silicone IOL produced a BCVA of 6/12 with a manifest refraction of À1.75 À1.00 Â 26 at 3 months. EyeDehiscence of radial keratotomy incision during phacoemulsification M Freeman et al 101 CommentDehiscence of RK incisions has been previously reported during penetrating keratoplasty, retinal detachment surgery and following blunt trauma. [1][2][3][4][5] There has also been a single case report of wound dehiscence during clear corneal cataract surgery 11 months after RK, which necessitated suturing of the keratotomy incision. 6 The slow healing of RK incisions is evidenced by clinical reports of late dehiscence, supported by histological findings. 7 Our patient developed dehiscence during phacoemulsification 14 years after RK. The calculation of IOL power in the presence of RK is reported to...

A retrospective noncomparative case-note analysis of 3 men presenting with persistent hypotony after routine phacoemulsification cataract surgery was performed. All patients had a previous history of significant blunt ocular trauma. All patients had surgical repair of the cyclodialysis clefts, 1 with cleft cryopexy and 2 with formal cleft closure with a limbal-based double scleral flap technique. All patients achieved closure of the cyclodialysis clefts following surgical intervention with complete resolution of hypotony. Mean preoperative intraocular pressures improved from 3, 4 and 3 mm Hg in the 3 cases to 11, 16, and 17 mm Hg postoperatively. Visual acuities improved from preoperative readings of counting fingers, 6/36 and 6/24 in the 3 cases to 6/6, 6/9, and 6/9 postoperatively. Persistent hypotony because of possible activation of a preexisting doormant cyclodialysis cleft following routine atraumatic phacoemulsification cataract surgery in previously traumatized eyes has not been reported.

A 45-year-old male presented with intractable glaucoma following 360-degree angle recession after blunt trauma. He underwent an uncomplicated trabeculectomy with mitomycin-C (MMC). Adequate precautions were taken to reduce the chances of sudden lowering of intraocular pressure (IOP). He did not have any intraoperative shallowing of the anterior chamber or postoperative hypotony, but still developed ocular decompression retinopathy. On detailed review of the previously reported cases we discovered that besides a large IOP drop after surgery, either the preoperative rise of IOP in all these cases was over a relatively short period or the course of their glaucomatous process was likely to have exposed them to intermittent spikes of high IOP. To our knowledge this factor has not been previously postulated in the pathophysiology of ocular decompression retinopathy. We illustrate this with a rare case of ocular decompression retinopathy after trabeculectomy with MMC for post-traumatic angle recession glaucoma.

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