Refractive Correction Of Visual Impairment Following Radial Keratotomy

Radial keratotomy (RK) was a refractive surgery performed in the 1980s and 1990s where radial incisions were made on the anterior surface of the cornea to flatten the central portion and correct myopia. Visual impairment due to hyperopia, diurnal fluctuations in vision, and an increase in irregular astigmatism are common long-term postoperative complications. The purpose of this study was to retrospectively investigate the refractive correction and treatment of patients with visual impairment after RK.

Osaka University Hospital, Osaka, Japan.

A retrospective chart review of patients with a history of RK who visited the university hospital from January 2010 to August 2022 was conducted.  Post-RK patients whose primary complaint was visual impairment were included in the study, while patients who were referred for treatment of cataracts, glaucoma, or other ocular diseases were excluded.  Purpose of visit, visual acuity, and refractive correction performed at the university hospital were reviewed as part of the study.

Of the 70 patients, 44 were identified for clinical outcomes. In 18 of these patients,  the consultation was terminated without corrective intervention, including no indication or only a trial of corneal rigid gas-permeable contact lens (corneal GP). In the remaining 26 patients, refractive or therapeutic intervention included corneal GP fit (16), spectacle prescription (6), corneal surgery for postoperative corneal scarring or endothelial dysfunction (3), and use of pilocarpine hydrochloride for photophobia (2). (The number of cases included duplicates.)  Fifteen patients are still receiving follow-up care. Uncorrected and corrected visual acuity at the initial visit did not differ between the no-intervention and intervention group.

Refractive or therapeutic intervention was possible in 59% of patients with postoperative visual deterioration after RK, and in the remaining 41%, therapeutic intervention was not possible. Corneal GP fit for corneal irregular astigmatism was the most common refractive intervention and was effective in 36% of cases in the university hospital, where availability of specialty lenses including scleral contact lenses is very limited due to regulations.