Diapositiva 1

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RUPTURE OF RADIAL KERATOTOMY WOUND WITH APHAKIA
AND ANIRIDIA BY BLUNT TRAUMA
Guifré Álvarez, Amanda Rey, Pablo Díaz ICOF.
Hospital Clinic i Provincial. Barcelona (Spain)
FINANCIAL DISCLOSURE The authors have no
financial interest in the subject matter of this
e-poster
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• PURPOSE
  
  
  
  To report a case of
  traumatic corneal rupture with extrusion of iris
  and lens, that occurred eight years after radial
  keratotomy, and its management.
• INTRODUCTION
• Radial keratotomy (RK) was the most widely
  carried out refractive surgical technique for the
  correction of myopia. Eventually, however, this
  practice has been abandoned with the development
  of laser eye surgery methods.
• In RK, severe complications such as photophobia,
  recurrent erosions, keratitis, cataract, micro or
  macoperforations, visual distortion of light,
  over or undercorrection, endophtalmiti. In
  addition, wound dehiscence have been reported,
  even several years after the surgery.

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• METHODS
• A 27 year-old man presented a corneal rupture in
  his left eye after blunt trauma
• 8 years ago a radial keratotomy (RK) was
  performed

• Slit lamp examination of his left eye showed
  dehiscence of the radial incision at three
  oclock position, extrusion of the iris and the
  lens, and a vitreous haemorrhage
• Ecography absence of iris and lens, no retinal
  detachment

At the emergency theatre the corneal laceration
was sutured with nylon 10-0 and a vitrectomy was
performed
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• - Two months after the surgery best corrected
  visual acuity was 20/30 with a rigid contact lens
  of 11 dioptres (D)
• - Because of intolerance to contact lens and
  extreme photophobia, at the eight month a 24D
  blue aniridia lens (Ophtec HMK ANI blue) was
  implanted using our habitual technique of sulcus
  fixation at the 2 and 8 oclock position with
  scleral patch for suture exposure (see video).

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• RESULTS
• 
  
  
  
  After this second surgery and
  suture removal at the third month of the
  postoperative course, best spectacle visual
  acuity improved to 20/25 (110º -1.00 -0.75) and
  the patient had no more complaints about
  photophobia.

B
A
A
Figures A and B corresponding at the first day
and second month, respectively, of the
postoperative
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• CONCLUSIONS
• RK structurally compromises the eye scars
  never regain the original tensile strenght of the
  unoperated cornea. Histopathologic and
  ultrastructural studies have demonstrated that
  the corneal keratotomy scars show incomplete
  healing.
• Even after several years after surgery, blunt
  traumas represent a definite risk for eyes
  undergoing radial keratotomy and patients should
  be counselled about it.
• Despite the severity of the traumatic incision
  rupture, some cases with a properly management
  can achieve good visual results.
• REFERENCES
• Rashid ER, Waring G. Complications of radial and
  transverse keratotomy. Surv Ophthalmol 1998 34
  73-106.
• Khoroshilova-Maslova IP et al. Clinical and
  histopathological examination of enucleated eyes
  with contusion ruptures of cornea after radial
  keratotomy. Vestn Oftalmol 1998 114 (4) 3-8
• Sony P. Traumatic corneal rupture 18 years after
  radial keratotomy. J Refr Surg 2004 20(3) 283-4