PURPOSE: To investigate the long-term results (at least 5 years of follow-up) of the mini asymmetric radial keratotomy (MARK) and corneal cross-linking (CXL) combined intervention, also known as the ‘Rome protocol,’ for patients with progressive stage I and II keratoconus and contact lens intolerance. METHODS: This was a retrospective observational case series. Fifteen eyes of 12 patients were evaluated, with a mean follow-up of 6.9 years. To assess the efficacy and stability of the MARK + CXL combined protocol, best spectacle-corrected visual acuity, mean pachymetry, and mean keratometry were recorded preoperatively and at least 1, 3, and 5 years postoperatively. Statistical analysis was performed using the R platform and involved the Wilcoxon signed-rank and Kruskal-Wallis non-parametric tests. RESULTS: Best spectacle-corrected visual acuity improved for all patients, from 0.46 ± 0.69 logarithm of the minimum angle of resolution (20 / 60) to 0.15 ± 0.69 logarithm of the minimum angle of resolution (20 / 30, p = 0.0006), while mean pachymetry increased in 93% of patients, from 442.80 ± 61.02 to 464.50 ± 62.72 µm (p = 0.003). Lastly, mean keratometry improved in 87% of patients after 6.9 years of observation from 48.82 ± 5.00 to 43.25 ± 3.58 diopters (p = 0.008). No intraoperative or postoperative complications were observed. CONCLUSIONS: The MARK + CXL combined protocol was effective in treating keratoconus by halting corneal thinning and bulging. In addition, this procedure significantly improved visual acuity based on long-term follow-up data. Analysis of data from a larger cohort of patients would be useful to support these findings.
Cohort Studies ; Follow-Up Studies ; Humans ; Keratoconus ; Keratotomy, Radial ; Postoperative Complications ; Retrospective Studies ; Visual Acuity

OBJECTIVETo explore the clinical characteristics of cataract surgery after radial keratotomy (RK) and appropriate calculation of intraocular lens (IOL) power.

METHODSEight patients with cataract (12 eyes) after RK were treated in our hospital from March, 2010 to June, 2013. The visual acuity, keratometric power and length of the ocular axis were examined before the operation. For each patient, 3 groups of corneal curvature values were measured using a automatic keratometer (TOPCON-KR8800) and the minimal K value was selected. Myopic or hyperopic posterior chamber IOL (-1.00 to -2.00 D) were selected based on automatic calculations with SRK-T. Phacoemulsification and IOL implantation were then performed, and the patients were followed up for visual acuity and refractive statuses at 3 months after the operation.

RESULTSAll the 12 operated eyes showed improved visual acuity after the operation. The uncorrected visual acuity reached 0.8 to 1.0 in 6 eyes and 0.4 to 0.6+ in the other 6, with a corrected visual acuity ranging from 0.6 to 1.0. The refractive status after operations was nearly emmetropic (+0.75 to -1.00 D) in 6 eyes and myopic in the other 6 (-1.00 to -2.50 D).

CONCLUSIONSPhacoemulsification and IOL implantation is feasible in cataract patients with previous RK. Selecting the minimal K values for central corneal curvature and calculation of the IOL power using the SRK T equation with a reservation of -1.00 to -2.00 D can better ensure the safety of the procedure and avoid the occurrence of hyperopia >+3.00D.

Cataract Extraction ; Cornea ; Humans ; Hyperopia ; Keratotomy, Radial ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Myopia ; Phacoemulsification ; Visual Acuity

PURPOSE: To report the long-term results concerning refractive changes after radial keratotomy in 6 eyes of 3 patients. CASE SUMMARY: We observed 3 patients who underwent radial keratotomy over 25 years previously. The positive effect of this surgery on the correction of refractive error decreased with increasing post-surgery time and myopic refractive errors accompanying astigmatism recurred. On average, refractive errors improved to 3.375 diopter (D) and corneal power improved to 2.954 D; in all cases, uncorrected visual acuities were not significantly improved. CONCLUSIONS: The effect of radial keratotomy on the correction of refractive errors decreased with time due to regression; myopic refractive errors recurred in the long-term.
Astigmatism ; Humans ; Keratotomy, Radial* ; Myopia ; Refractive Errors ; Visual Acuity

PURPOSE: To report a patient who underwent successful cataract surgery without wound dehiscence in the eye that had undergone previous radial keratotomy by performing a clear corneal incision between previous incisions. CASE SUMMARY: A 59-year-old female visited our medical center for decreased vision. The patient underwent radial keratotomy for correction of myopia in both eyes 11 years prior. On slit-lamp examination, cataract and eight radial keratotomy incisions were found. Phacoemulsification and posterior capsule intraocular lens implantation were performed for both eyes at a one-week interval. For the right eye, a clear corneal incision was made over the previous incision scar and wound dehiscence was successfully managed by prompt corneal suturing. For the left eye, a clear corneal incision was made between the previous incision scars, and wound dehiscence did not occur. CONCLUSIONS: As radial keratotomy patients age, cataract surgery should be considered. A successful surgery was possible without wound dehiscence in an eye that had undergone previous radial keratotomy in which a clear corneal incision was made between previous incision scars.
Cataract* ; Cicatrix ; Female ; Humans ; Keratotomy, Radial* ; Lens Implantation, Intraocular ; Middle Aged ; Myopia ; Phacoemulsification ; Wounds and Injuries

BACKGROUNDCorneal curvatures measured by conventional instruments after refractive surgeries were greater than the real values. This study on the instruments and methods for measuring corneal curvature was carried out with the aim of determining an accurate, simple and effective method to evaluate corneal refractive power after radial keratotomy (RK).

METHODSA retrospective study was carried out on 52 eyes of 42 patients with a history of RK. The postoperative measurements after RK were performed with a manual keratometer (Rodenstock, Munchen-Hamburg, Germany), a corneal topographer (Tomey TMS-1) and an automated IOLMaster keratometer (Carl Zeiss GmbH, USA). The results obtained from analyzing clinical histories (clinical history method, CHM) were compared to the postoperative measurements with a two-way analysis of variance. Adjusted keratometry was used to correct the corneal central refractive power (K) values of the three keratometers. The CHM results were also compared to the corrected K values obtained with the three keratometers using the same statistical method.

RESULTSThe smallest mean value was found for the CHM ((36.61 ± 2.23) diopters). The K values obtained with the CHM were very different from the results obtained with the three different instruments. The corrected K values obtained with the IOLMaster were the closest to the K values from the CHM.

CONCLUSIONSIt was shown that K values from measurements with the three instruments were higher. When the power of the intraocular lens of the patients after RK was calculated, the errors of the K values measured with the instruments should be taken into consideration.

Adult ; Cornea ; anatomy & histology ; Corneal Topography ; Female ; Humans ; Keratotomy, Radial ; Male ; Retrospective Studies

PURPOSE: To elucidate a proper method of intraocular lens (IOL) power calculation in highly myopic eyes with previous radial keratotomy (RK). METHODS: Five post-RK-surgery eyes with pre-RK-surgery myopia over -10.0 diopters (D) were studied retrospectively. The keratometric values obtained via the clinical history method, the contact lens over-refraction method, conventional keratometry, and Orbscan II were compared to the true keratometric value calculated retrospectively using the SRK/T formula. RESULTS: The mean pre-RK-surgery refractive power was -19.35+/-5.86D (-14.50 ~ -29.50D) and cataract surgery was performed on average 16.6 years after RK. The true keratometric value was closest to that estimated by the contact lens over-refraction method in 1 eye and to the flatter keratometric value between Sim K and the 3mm zone mean Pwr obtained with axial keratometric power map of Orbscan II in 4. CONCLUSIONS: The flatter keratometric value between Sim K and the 3mm zone mean Pwr from Orbscan II was closest to the true post-RK-surgery keratometric value of the central cornea.
Cataract ; Cornea ; Keratotomy, Radial* ; Lenses, Intraocular* ; Myopia ; Retrospective Studies

PURPOSE: To compare the accuracy of the intraocular lens (IOL) power calculation of clinical history method, with contact lens overrefraction method or computerized videokeratography method in the eyes with previous radial keratotomy (RK) METHODS: The medical records of 2 patients (3 eyes) who had previous RK, and recent phacoemulsification with posterior chamber lens implantation were retrospectively reviewed. All surgical procedures were performed by one surgeon. The power of implanted IOL was calculated by using clinical history method and SRK/T formula. Keratometric (K) value was measured with contact lens overrefraction and computerized videokeratography method before cataract extraction. Ideal keratometric value was calculated from the final postoperative spherical equivalent and the power of implanted IOL retrospectively, and then compared to K value of each method. RESULTS: Mean differences between the ideal K value and K value was 1.48 diopters in computerized videokeratography method, 2.54 diopters in clinical history method, and 3.65 diopters in contact lens overrefraction method, respectively. CONCLUSIONS: Unintentional hyperopia can be decreased by intentional postoperative myopia and obtaining K value by the computerized videokeratography method in cataract surgery of the eyes with previous radial keratotomy.
Cataract Extraction ; Cataract* ; Corneal Topography ; Humans ; Hyperopia ; Keratotomy, Radial* ; Lenses, Intraocular* ; Medical Records ; Myopia ; Phacoemulsification ; Retrospective Studies

The second survey which was composed of questionnaires on a variety of ophthalmic topics was made up and sent to members of the Korean Society of Cataract and Refractive Surgery(KSCRS) in March, 1997. The second survey was composed of 80 items, including 8 additional items compare to the first survey in 1996. Forty-three percent(65/150) responded and the results were compared to these of the first survey.Over half of the respondents(64%) were in their forties. Catarct operation accounted for over 60% of the total operations in 75% of KSCRS members which was increased compared to previous survey(45%). The 0-2 days of admission in the cataract surgery was 56% of respondents that was increased than previous survey(36%). Increased preference to 3.5mm incision and 5.5mm incision in cataract operation and increased use of 5.5mm optic size IOL(47%) in phacoemulsification surgery compare to previous survey in that 6.0mm optic size IOL was mostly used were shown which indicate increase of small incision cataract surgery.For radial keratotomy as a means of correcting myopia, 97% of the respondents were not performing the procedure. Fortu-six percent of the respondents have been doing excimer laser photorefractive keratectomy which was decreased than previous survey(54%).For use of foldable IOL. which was one of new question items, 50% of respondents answered they use it in less than 20% of cataract surgery which indicates foldable IOL is not popularly used.These results reflect the present trends of cataract and refractive surgeries in Korea.
Cataract* ; Surveys and Questionnaires ; Keratotomy, Radial ; Korea ; Lasers, Excimer ; Myopia ; Phacoemulsification ; Photorefractive Keratectomy ; Refractive Surgical Procedures*

A questionnaire on a variety of ophthalmic topics was made up and sent to 150 members of the Korean Society of Cataract and Refractive Surgery-[KSCRS] in May, 1996. Forty percent [60/150] responded within the deadline in June, 1996. As the contents of the questionnaire were almost identical to the ones prepared in the USA [1994, 1995] and in Japan [1994], the answer to the questionnaire could be compared with those gathered from the USA and Japan. Over half of the respondents [57%] were in their forties. The average number of operations done per month was 26. Cataract operation accounted for over 60% of the total operations in 34% of KSCRS members. And more than 76% of the cataract operation were done using phacoemulsification technique in 31% of the respondents. There were no difference in the preferred method of local anesthesia for the cataract surgery in Korea compare to the USA or Japan. And there was less likelihood of using peribulbar anesthesia and no suture technique in Korea compared to the USA. Sixty-one percent of the Korean ophthalmic surgeon implanted the intraocular lenses even before the patients were younger than 20 years old whereas, 82% of ophthalmic surgeon in Japan did only when the patients were older than 20 years of age. For radial keratotomy as a means of correcting myopia, 91% of the Korean respondents were not performing the procedure any more, while 45% of the American respondents abandoned it. Fifty four percent of the Korean respondents and 46% of the American respondents have been doing excimer laser photorefractive keratectomy. There was no statistical difference between the two. From the answers to the qustionnaire, we found that our results did not differ significantly from those of the USA or Japan and we believe that these results reflect the present trends of cataract and refractive surgeries in Korea.
Anesthesia ; Anesthesia, Local ; Cataract* ; Surveys and Questionnaires ; Humans ; Japan ; Keratotomy, Radial ; Korea ; Lasers, Excimer ; Lenses, Intraocular ; Myopia ; Phacoemulsification ; Photorefractive Keratectomy ; Refractive Surgical Procedures* ; Suture Techniques ; Young Adult

The authors report clinical results of 6 myopic patients(6 eyes) who showed undercorrection following keratomileusis-in-situ and then underwent radial keratotomy to correct the residual myopia. The mean age of patients was 39.2 years, and the mean interval between keratomileusis and radial keratotomy was 19.8 months. The mean refractive error was changed from -7.0D preoperatively to -3.23D after radial keratotomy. 'The average difference of refractive error between treated eye and untreated fellow eye was changed from 5.12D to 1. 63D after radial keratotomy. The mean visual acuity was changed from 0.15 preoperatively to 0.33 after radial keratotomy. In conclusion, radial keratotomy is an useful procedure for correcting undercorrected myopia after keratomileusis in situ.
Humans ; Keratotomy, Radial* ; Myopia* ; Refractive Errors ; Visual Acuity