Challenges In Cataract Surgery With Prior Radial Keratotomy

To identify the challenges in cataract surgery with prior radial keratotomy. The difficulties faced during diagnostic procedures, differences in the calculation of intraocular lens power, intraoperative challenges and postoperative outcomes.

A case report of a 60 year old male who underwent Radial Keratotomy with 12 incisions in both eyes 30 years back. Patient now underwent cataract surgery with intraocular lens implantation in the left eye.

The procedure of cataract surgery in patients who underwent RK is challenging for cataract surgeons due to difficulties in preoperative measurements of IOL as well as high expectations of patients regarding good vision after surgery. Difficulties in determining the curvature of the cornea and performing the calculation of the appropriate IOL power caused by corneal irregularities after RK. ASCRS post RK online calculator and Barrett True K methods were used to in order to prevent a postoperative refractive surprise. The averaged results of the available formulas were used. Cataract phacoemulsification increases the risk of RK incisions dehiscence or rupture. In this case the main incisions were made more circumferentially than in standard cataract surgery in order to minimize above the risks. Lateral incisions were made between two neighbouring scars after RK. Postoperatively wound dehiscence was noted even though no sutures were needed.

Cataract surgery in patients who underwent RK is challenging for cataract surgeons due to difficulties encountered while choosing IOL power, planning the location of corneal incisions and a prolonged corneal regeneration after the procedure. It is hard to meet patients’ expectations when it comes to achieving spectacle independence after the procedure. Monofocal lenses give a chance to achieve satisfactory postoperative effects, while avoiding the typical side effects seen after multifocal lenses.