Abstract
Purpose: :
The authors report the case of a multiple rupture of radial keratotomy (RK) incisions which occurred during a clear corneal microcoaxial phacoemulsification 19 years after refractive surgery.
Methods: :
Operated 19 years earlier by RK for a bilateral moderate myopia (about - 5 D), a 62-year-old woman was referred to us for the decline of her left one-sided visual acuity because of evolved cataracts. Realized in 1991, RK happened without particular incident. 4 incisions of 3mm of length and 500µm of depth were made from the edge of the outer clear zone to the periphery, leaving a small margin of uncut cornea at the limbus. The BCVA were of 160/200 P2 for her right eye with a correction of -4.00 (0° -1.50) D and 80/200 P3 for her left eye with -7.00 ( 160° -2.75 ) D. The patient presented evolved bilateral nuclear cataracts so an indication of clear corneal cataract surgery of her left eye was retained. The scars of RK were noted down as almost hard to see in preoperative.
Results: :
The microcoaxial clear corneal phacoemulsification (2.2mm incision, stellaris Bausch&lomb,Rochester, NY) happened without incident until the end of the phase of divide and conquer where a sudden collapse of the anterior chamber was noted, complicated with a break of the posterior capsule. After the interruption of the operation, it appeared that both superior corneal incisions located on the axes of 70 and 110° had completely opened, explaining the collapse of the anterior chamber. After a suture of the two worn-out sections, each by two separated points of nylon 10/0, the intervention could start again and allowed a cleaning of the anterior chamber, a complementary anterior vitrectomy and a final implantation with a MTA4UO IOL of 17 D ( Alcon labs, Forth Worth, TX). Post operatively, no complications were noted. After sutures ablation 2 months later, the BCVA on this left eye was of 120/200 with a correction of -1.00 (100 ° + 2.00) D.
Conclusions: :
Only two similar cases were described in literature: in 1998 by Budak and in 2001 by Behl. In both cases, the break of RK scar concerned only a single scar and had arisen very early after the KR for the first case (9 months later), and 11 years later for the second. Our clinical case shows that even 20 years after RK, the corneal fragility is such that a break may arise during clear corneal phacoemulsification. When the main met problem concerns today the biometric calculation of the implants, we warn against the rupture always possible of old RK incisions, even 20 years after the procedure.
Keywords: refractive surgery: complications • small incision cataract surgery • trauma