Corneoscleral Rupture Ten Years After Radial Keratotomy

McDermott, Mark L.; Wilkinson, W. Scott; Tukel, David B.; Madion, Matthew P.; Cowden, John W.; Puklin, James E.

doi:10.1016/s0002-9394(14)77891-2

Cited by 15 publications

(4 citation statements)

References 4 publications

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“…Case reports of traumatic globe rupture after RK have been published, which stress the vulnerability of these corneas to trauma [4][5][6][7][8][9][10]. Vinger et al [8], in a study of 28 cases, found that the rupture extended across the visual axis in 13 patients, which they suggested occurred due to the close proximity of the incisions to the visual axis.…”

Section: Discussionmentioning

confidence: 99%

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Ruptured globe 20 years after radial and transverse keratotomy

Jammal

Dolat

2012

Int Ophthalmol

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To report a case of corneal rupture due to blunt trauma occurring 20 years after radial keratotomy (RK) and transverse keratotomy. A 57-year-old woman sustained direct blunt trauma to her right eye. Ocular examination revealed a ruptured globe involving two of the eight RK incisions connected together across the visual axis with iris incarceration in the wound. The transverse keratotomy scars remained intact. The patient underwent primary corneal wound repair and iris repositioning. The postoperative period was uneventful. The patient had a visual acuity of counting fingers at 1 m and is awaiting penetrating keratoplasty. Traumatic rupture of RK incisions can still occur after 20 years. Patients having undergone RK many years before should be warned of a possible life-long risk of traumatic rupture. RK scars appear to be more vulnerable to rupture than astigmatic keratotomy scars.

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Section: Discussionmentioning

confidence: 99%

“…Weakening of the cornea by the RK incisions is well known and predisposes the cornea to rupture by less force than usual [3]. Several reports have described globe rupture after blunt trauma in patients who had RK after variable periods of time [4][5][6][7][8][9][10]. We present a case presenting with globe rupture 20 years after RK.…”

Section: Introductionmentioning

confidence: 99%

Ruptured globe 20 years after radial and transverse keratotomy

Jammal

Dolat

2012

Int Ophthalmol

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“…6 Previous reports suggest considerable variability in corneal strength following RK. [2][3][4][5][6][7][8] We are aware of three published cases of RK incision rupture during phacoemulsification cataract surgery. Budak et al 2 reported RK incision dehiscence in a patient who had RK 11 months before cataract surgery.…”

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confidence: 99%

Delayed radial keratotomy dehiscence following uneventful phacoemulsification cataract surgery

Day

Seward

2007

Eye

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Sir, Delayed radial keratotomy dehiscence following uneventful phacoemulsification cataract surgery A 73-year-old female was referred with cataracts. Bilateral radial keratotomy (RK) had been performed 9 years previously for high myopia; on her left eye this had been supplemented with astigmatic keratotomies. Best-corrected visual acuities were 6/36 right eye and 6/12 left eye. She had bilateral moderate nuclear sclerotic cataracts. Fundoscopy showed healthy discs with a right epiretinal membrane and normal left macular. She chose to have left cataract surgery following detailed discussion with specific mention of complications associated with previous RK.Routine phacoemulsification cataract extraction was performed under subtenons anaesthesia. The clear corneal main incision was located temporally between RK incisions and was secured at the end of the procedure with a single 10/0 Vicryl suture. She was examined before discharge and had a deep anterior chamber and negative Siedel's test. Acetazolamide 250 mg was given for postoperative IOP prophylaxis.Day one review showed a shallow anterior chamber with two Seidel positive temporal RK incisions. She was taken to theatre and one incision closed with a 10/0 nylon suture and a bandage contact lens inserted (Figure 1). Four months postoperatively her visual acuity is 6/6 with refraction À0.25/À2.00 Â 7.5 CommentPrevious RK not only complicates intraocular lens power selection due to unintentional postoperative hyperopia and postoperative hyperopic shift, 1 but can also reduce corneal tensile strength. RK incision dehiscence has been reported during phacoemulsification cataract surgery 2-4 corneal transplantation 5 and following blunt trauma including car airbag inflation. 6 Previous reports suggest considerable variability in corneal strength following RK. [2][3][4][5][6][7][8] We are aware of three published cases of RK incision rupture during phacoemulsification cataract surgery. Budak et al 2 reported RK incision dehiscence in a patient who had RK 11 months before cataract surgery. This occurred during construction of a 3.0 mm incision that intersected one of the radial incisions. Following suturing of the wound, the remainder of the procedure was uneventful. In the other two cases, RK dehiscence occurred during the phacoemulsification stage. 3,4 In all cases there was very good visual rehabilitation.The reason why delayed RK dehiscence occurred in our patient is not known. The astigmatic keratotomy incisions traversing radial cuts will have further weakened the cornea compared with simple RK. As trauma to the eye is unlikely because the clear shield was only removed at the day one examination, we speculate

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“…7 Another report cites examples of corneal rupture through RK incisions after blunt trauma as late as after 10 years 8. Although the incidence and need for RK have been decreasing for several years because of the introduction and increase of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) using the excimer laser, there remain a huge number of patients who have undergone RK, and the procedure remains a valuable method for correction of moderate myopia, notably because of its minimal cost 9…”

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confidence: 99%