We have covered the topic of cataract surgery in eyes with prior radial keratotomy (RK) but this case is unusual because there are so many RK cuts in the patient’s cornea. The issue is whether we need to make a scleral tunnel incision or can we fit our phaco incision between the existing RK incisions without intersecting them. Because the RK that was performed was asymmetrical, there are two areas at the limbus where we can squeeze our incision: one is nasal at about the 170° axis nasally, which is difficult to use for cataract surgery due to the close proximity to the patient’s nose, and one at 45° supero-temporally which we can use.
We adjust the speculum and our seating position so that we can make the phaco incision with the 2.2 mm diamond keratome at this supero-temporal position. We can then be sure to avoid intersecting the RK incisions with our phaco incision. The case proceeds smoothly and at the end of the case we use fluorescein dye to check all of the incisions to ensure that they are watertight. This includes the phaco incision, the paracentesis incision, and all 20 prior radial keratotomy incisions.
Tomorrow and the next day we will again feature cases of cataract surgery in eyes with prior RK and we will include a detailed process to help with the IOL power estimation.
Click below for cataract surgery in an eye with prior 20-cut radial keratotomy:
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