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

Abstract

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.

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

“…In the literature, the reported cases of ocular perforation after radial keratotomy were mostly in the late postoperative period of the surgery and related to ocular trauma. 6,7 In our case, the perforation occurred 26 years after the RK surgery, which may show us that corneal instability can increase as time passes, with microtrauma, such as eye scratching, constant eyelid movement in the blinking motion, and in the case of contact lens wear, through the daily manipulation of placing and removing these lenses. 10 Another factor that may have facilitated the perforation in the reported case was the other two previous refractive surgeries performed on the same eye, which made the cornea thinner and more susceptible to changes.…”

“…There are several descriptions in the literature of ocular perforation in patients in the late postoperative period of radial keratotomy, mostly related to ocular trauma. 6,7 What corroborates this fact is that the ocular perforation occurred precisely in one of the areas of one of the incisions. In addition, the wound dehiscence, in our case, occurred during manipulation of the eye with suction cup removal, which can be considered as a mild ocular trauma.…”

“…Such corneal fragility can generate more dramatic cases of ocular perforation, associated or not associated with ocular trauma. 6,7 Despite these complications, which contributed to the surgery to be discontinued, ophthalmologists still followed up post-RK patients and their consequences.…”

BCLA CLEAR – Medical use of contact lenses

“…BSCLs have been used after penetrating keratoplasty to enhance reepithelialisation, prevent suture irritation, smooth irregularities in the wound margin, and to act as a tamponade for wound leaks since the mid-1970's [182][183][184][185]. In a randomised prospective study, 14 of 26 patients that underwent either deep anterior lamellar keratoplasty or penetrating keratoplasty were fitted with BSCLs and compared to a no lens control group [186].…”