The cornea in patients with prior radial keratotomy is very delicate and prone to a higher rate of complications during cataract surgery. We can make our phaco incision in such a way that we minimize these risks and produce an entry that heals very well. Looks carefully at the title photo and you will see that I use a small diamond keratome to go between two RK cuts without intersecting them. The limbal vessels are also barely nicked to ensure great long term sealing and the tunnel length and incision architecture are both appropriate and precise. This video gives my best pearls for making incisions in these RK eyes. We also discuss why the RK incisions temporarily swell in the post-op period and how that affects the refractive outcome. So much to learn with these RK eyes and I’m happy to share my knowledge gleaned after performing about 100 or more cataract surgeries on RK eyes per year and more than 1,000 in my career so far.