ESCRS - PO0165 - Traumatic Corneal Rupture 20 Years After Radial Keratotomy

Traumatic Corneal Rupture 20 Years After Radial Keratotomy

Published 2023 - 41st Congress of the ESCRS

Reference: PO0165 | Type: Case report | DOI: 10.82333/4c4e-gj47

Authors: Marco Piergentili* 1 , Saverio Frosini 1 , Lorenzo Cifarelli 1 , Stefano Mercuri 1

1Ophthalmology,Careggi,Florence,Italy

To report a case corneal rupture with iris prolapse in a patient previously treated with radial keratotomy, following a blunt trauma.

A 46-year old male underwent radial keratotomy 20 years before he sustained an eye trauma from a soccer ball. Surgery was performed the same day to repositioning the iris and sutureless. Anterior segment optical-coherence tomography (SA-OCT) and corneal topography (MS39 , CSO) were performed preoperatively and at day 14 after surgery,  along with slit lamp photographs, visual acuity measurement and complete slit lamp examination. 

A 46-year old male presented to the eye casualty with ocular pain, photophobia and decreased vision of 20/40 (Snellen) in his left eye following a blunt injury during a soccer match. The incision site from radial keratotomy had evidence of rupture with iris prolapse, sealing the wound without humor aqueous leakage. Upon examination, the pupil was irregular in shape with iris tears despite a preserved pupillary light reflex. Surgery was performed under local anesthetic (Lidocaine), two port incision were made and the iris reposionated with a dispersive low density viscoelastic cannula (Viscoat, Alcon) to avoid possible post operative hypertonia. Irrigation/Aspiration was not performed in order to avoid any cataractogenic stimuli. At the end of the surgery a soft therapeutic bandage contact lens was placed without the necessity to suture the corneal wound, with no humor aqueous leakage. At day 1 and 7 a complete ocular examination was carried out with no post operative complications and intraocular pressure within normal limits. Two weeks following the injury, the patient had corrected visual acuity of 20/20 -2  in the affected eye. At that time, the RK wound was well healed with minimal pigmentation at the edges  as shown by AS-OCT. The patient reported halos and photophobia due to the iris tears and related traumatic mydriasis. Ongoing monitoring will be necessary to assess the necessity of further treatment to ensure a satisfied visual outcome.

This case demonstrates the excellent recovery of visual acuity and anterior segment anatomy in a patient who underwent surgery after full thickness traumatic corneal wound rupture 20 years following radial keratotomy. The concept was to be as less surgically aggressive possible. Traumatic mydriasis, caused by damage to the sphincter pupillae muscle and responsable of patient's complaints was the main postoperative issue, which will need further monitoring.