Cornea and External Diseases

Radial Keratotomy Complication

Macroperforation and extension of the incision across the optical zone is treated with cyanoacrylate glue.
  • Refractive surgery procedure to correct mild to moderate degrees of myopia (2 to 5 D)

Principle

  • Creating a series of radial corneal incisions.
  • These incisions weaken the corneal structure and induce a slight bulging of the mid peripheral corneal with an associated flattening of the central optical zone.
  • Surgical complications may include:
    • Microperforation
    • Full thickness corneal perforation, which may lead to intraocular infection, endothelial damage, corneal decompensation, iris or lens injury, and induction of irregular astigmatism
    • Decentration
    • Incorrect use of the surgical nomogram
    • Inadvertent extension of the incision into the optical zone
  • Postoperative problems may include:
    • Symptoms of ocular pain, glare, photophobia, diminished quality of vision and lost of best corrected visual acuity
    • Irregular astigmatism
    • Contact lens fitting problems
    • Epithelial plugs filling the incisions with secondary wound gap
    • Infection complicated with delayed wound healing
    • Scarring
    • Limbal vascularization

Management

  • If the perforation is extensive and non self-sealing (macro-perforation) it must be sutured to restore the ocular integrity.
  • Reduced visual function not amenable to non-surgical treatment such as spectacle correction or contact lenses may be treated surgically with:
    • Excimer laser phototherapeutic treatment
    • LASIK
    • Penetrating keratoplasty.
Infection involved the optical zone complicated with delayed wound healing.