Refractive Complications of Cataract Surgery After Radial Keratotomy

Koch, Douglas D.; Liu, John F.; Emery, Jared M.; Hyde, Lawrence L.; Rock, Robert L.

doi:10.1016/0002-9394(89)90860-x

Cited by 157 publications

(91 citation statements)

References 9 publications

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“…As the interval between RK and cataract surgery increases, incision integrity improves and corneal flattening is less evident. 8 In our case, the 14-year gap between RK and phacoemulsification might explain the refractive stability demonstrated by postoperative topography.…”

Section: Commentmentioning

confidence: 55%

“…The calculation of IOL power in the presence of RK is reported to be inaccurate in the absence of pre-RK keratometry with a high incidence of postoperative central corneal flattening and hyperopic shift. 8,9 In our case, pre-RK keratometry was not available at the time of surgery, hence we relied on prephacokeratometry and B-scan axial length measurements using the Holladay formula to calculate IOL power. This simple method produced a satisfactory prediction of lens power for both eyes.…”

Section: Commentmentioning

confidence: 99%

“…8,9 In our case, pre-RK keratometry was not available at the time of surgery, hence we relied on prephacokeratometry and B-scan axial length measurements using the Holladay formula to calculate IOL power. This simple method produced a satisfactory prediction of lens power for both eyes.…”

Section: Commentmentioning

confidence: 99%

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Dehiscence of radial keratotomy incision during phacoemulsification

Freeman

Kumar

Ramanathan

et al. 2004

Eye

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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...

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Section: Commentmentioning

confidence: 55%

Section: Commentmentioning

confidence: 99%

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Dehiscence of radial keratotomy incision during phacoemulsification

Freeman

Kumar

Ramanathan

et al. 2004

Eye

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“…Tais variáveis são também importantes no caso de se considerar cirurgia de catarata. (42)(43)(44) O aplanamento da córnea pode ser acentuado no pós-operatório imediato, levando a uma relativa surpresa hipermetrópica transitória. Tal fenômeno ocorre devido ao edema corneano juntamente com a possível hipertensão ocular.…”

Section: Discussionunclassified

Hipermetropia após ceratotomia radial: flutuação da refração e da acuidade visual entre manhã e tarde e correlações com a pressão ocular e o estado biomecânico da córnea

Ambrósio¹,

Silva²,

Lopes³

et al. 2012

Rev. bras.oftalmol.

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RESUMOObjetivo: Verificar as variações entre manhã e tarde da refração, da acuidade visual, das medidas da pressão ocular e dos parâmetros biomecânicos da córnea em pacientes operados de ceratotomia radial e interesse em retratamento refrativo; correlacionar os parâmetros biomecânicos da córnea com a refração, com a acuidade visual e com as suas variações. Métodos: Foram examinados trinta e oito olhos de 19 pacientes pela manhã (9 am) e à tarde (6 pm), obtendo-se refração esfero-cilíndrica dinâmica, acuidade visual (logMAR) sem correção (AVsc) e corrigida (AVcc) e parâmetros do ORA (Ocular Response Analyzer): histerese corneana (corneal hysteresis -CH), fator de resistência da córnea (corneal resistance factor -CRF), pressão intraocular (intraocular pressure -IOP) calibrada para o padrão Goldmann (IOPg) e pressão compensada da córnea (IOPcc). Considerando a não distribuição normal das variáveis (teste de Kolmogorov-Smirnov), o teste de Wilcoxon signed rank foi utilizado para verificar significância nas diferenças entre as medidas da manhã e as da tarde de cada variável. O teste de Spearman foi utilizado para verificar correlações das medidas do ORA com o estado refracional e com a acuidade visual pela manhã e à tarde, assim como para verificar as correlações entre as medidas do ORA pela manhã e à tarde e as variações da refração e da acuidade visual. Resultados: Grau esférico (E), equivalente esférico (EE), equivalente desfoco (ED), AVsc, IOPcc e IOPg variaram significativamente (Wilcoxon, p<0,05) entre manhã e tarde, havendo maior hipermetropia, pior acuidade visual não corrigida, maior pressão ocular e menor CH pela manhã. Nas medidas pela manhã, observaram-se correlações positivas (Spearman, p<0,05) do EE e do ED com IOPcc (rs=0,39 e 0,34 respectivamente), mas não com IOPg. Nas medidas da tarde, não houve correlações significantes entre os parâmetros refracionais e os pressóricos. Observaram-se correlações negativas (Spearman, p<0,05) entre AVsc (logMAR) e CH pela manhã e à tarde (rs= -0,48 e rs= -0,51), entre E e CH pela manhã e à tarde (rs= -0,66 e -0,76), entre E e CRF pela manhã e à tarde (rs= -0,40 e -0,47), entre EE e CH pela manhã e à tarde (rs= -0,70 e -0,68), entre EE e CRF pela manhã e à tarde (rs= -0,41 e -0,46), entre ED e CH pela manhã e a tarde (rs= -0,64 e -0,54) e entre ED e CRF pela manhã e a tarde (rs= -0,35 e -0,34). Observou-se correlação significante e negativa do CRF pela manhã com a variação do ED (p = 0,05; rs = -0,30) e com a variação da AVsc (p = 0,04; rs = -0,33). Conclusão: Maior hipermetropia pela manhã foi associada a maior pressão compensada (IOPcc), mas não com IOPg em pacientes operados de ceratotomia radial, o que deve ser considerado no planejamento do retratamento refrativo. Parâmetros biomecânicos (CRF e CH) mais baixos foram associados com maior hipermetropia e pior acuidade visual. Uma tendência de haver maior flutuação relacionada com córneas mais fracas foi encontrada. Novos estudos envolvendo parâmetros biomecânicos derivados do sinal do ORA, além dos parâmetros CH e ...

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“…Owing to the change from sphere to asphere after refractive surgery, measurements of corneal radii and power, respectively, are very likely to be inaccurate. 1,2 Corneal power is overestimated followed by an underestimation of IOL power resulting in hyperopia postoperatively. 3,4 Moreover, this overestimation of K-readings is increased by a reduced refractive corneal index, which is determined by the two refractive surfaces of the cornea.…”

Section: Introductionmentioning

confidence: 99%

Intraocular lens power calculation using ray tracing following excimer laser surgery

Rabsilber

Reuland

Holzer

et al. 2006

Eye

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Purpose To evaluate intraocular lens (IOL) power calculation using ray tracing in patients presenting with cataract after excimer laser surgery. Methods Ten eyes of seven consecutive patients who presented for cataract surgery following excimer laser treatment without any pre-refractive biometry data were enrolled in this prospective clinical study. Preoperatively, IOL power calculation was performed using a ray tracing software called OKULIX. Keratometry data (C-Scan) were imported and axial length (IOLMaster) was entered manually. Accuracy of IOL power calculation was investigated by subtracting attempted and achieved spherical equivalent. Conclusions IOL power calculation after excimer laser surgery can be difficult, especially when pre-refractive keratometry values are not available. In these cases, ray tracing combined with corneal topography measurements provides reliable and satisfactory postoperative results. However, it is advisable to be careful when calculating IOL power for eyes with corneal radii exceeding 10 mm because of slightly higher prediction errors.

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Refractive Complications of Cataract Surgery After Radial Keratotomy

Cited by 157 publications

References 9 publications

Dehiscence of radial keratotomy incision during phacoemulsification

Dehiscence of radial keratotomy incision during phacoemulsification

Hipermetropia após ceratotomia radial: flutuação da refração e da acuidade visual entre manhã e tarde e correlações com a pressão ocular e o estado biomecânico da córnea

Intraocular lens power calculation using ray tracing following excimer laser surgery

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