Phacoemulsification of Cataract in Patients Undergone Anterior Radial Keratotomy

The aim of the investigation was to specify the conditions of performing cataract phacoemulsification in patients with previous anterior radial keratotomy (ARK), enabling optimization of the operation results.

Materials and Methods. We examined 27 patients (46 eyes) at the age of 44–62 years suffering age-related cataract of various density, who underwent ARK for myopia and myopic astigmatism 22.8±1.4 years ago. Before the operation the refracting power of the cornea and axial eye length were determined. Intraocular lens power was calculated with the help of Hoffer Q formula with corrections. All patients underwent cataract phacoemulsification with implantation of foldable intraocular lenses in the capsular bag through the tunnel-shaped corneal or scleral access 2.2 mm wide.

Results. All operations were uneventful. Visual acuity without correction increased from 0.18±0.07 to 0.54±0.07 (p<0.05) on average, with correction from 0.29±0.04 to 0.89±0.04 (p<0.05). Clinical refraction reached –1.35±0.37 D on average. Endothelial cell loss was 5.3% and did not exceed it in uncomplicated phacoemulsification. Creation of a “safety zone” in the form of intact cornea between the tunnel margins and keratomic scars not less than 0.5 mm wide prevented the risk of scar dehiscence during separate steps of phacoemulsification.

Conclusion. Precise determination of refracting corneal power and axial eye length, application of the third-generation Hoffer Q formula with corrections, individual approach to the operation access selection depending on the width of the “safety zone” between the tunnel margins and keratomic scars, measures taken to protect endothelium during the operation allow the achievement of high functional results after cataract phacoemulsification in patients undergone ARK.

1. Avetisov S.E., Mamikonyan V.R., Kas’yanov A.A. Calculation of IOL optical power in patients with radial keratotomy in the medical history. Oftal’mologiya 2004; 1(4): 15–24.
2. Neroev V.V., Tarutta E.P., Khodzhabekyan N.V., Khandzhyan A.T., Penkina A.V., Milash S.V. Using Galilei G2 scheimpflug analyser to determine anatomical and optical parameters of the cornea after refractive corneal surgery. Rossiyskiy oftal’mologicheskiy zhurnal 2014; 2: 5–9.
3. Iusef Iu.N., Kas’ianov A.A., Ivanov M.N., Iusef S.N., Vvedenskii A.S., Ryzhkova E.G., Shevelev A.Iu. Calculation of intraocular lens power in non-standard clinical situations. Vestnik oftal’mologii 2013; 129(5): 62–66.
4. Geggel H.S. Intraocular lens power selection after radial keratotomy. Ophthalmology 2015; 122(5): 897–902, http://dx.doi.org/10.1016/j.ophtha.2014.12.002.
5. Gusev Yu.A., Belikova E.I., Tret’yak E.B., Zhezheleva L.V. Intraocular lens power calculation after radial keratotomy (clinical case). Kataraktal’naya i refraktsionnayakhirurgiya 2015; 15(2): 41–46.
6. Lyle W.A., Jin G.J. Intraocular lens power prediction in patients who undergo cataract surgery following previous radial keratotomy. Arch Ophthalmol 1997; 115(4): 457–461, http://dx.doi.org/10.1001/archopht.1997.01100150459001.
7. Rajan M.S., Keilhorn I., Bell J.A. Partial coherence laser interferometry vs conventional ultrasound biometry in intraocular lens power calculations. Eye 2002; 16(5): 552–556, http://doi.org/10.1038/sj.eye.6700157.
8. Stakheev A.A., Balashevich L.I. A new method of calculating intraocular lens power for patients with cataract undergone previously radial keratotomy. Oftal’mokhirurgiya 2008; 2: 26–33.
9. Seitz B., Langenbucher A. Intraocular lens power calculation in eyes after corneal refractive surgery. J Refract Surg 2000; 16(3): 349–361.
10. Khoroshilova-Maslova I.P., Andreeva V.P., Ilatovskaya L.V., Kuznetsova I.A. Clinical and histopathological investigation of enucleated eyes with contusion corneal rupture after radial keratotomy. Vestnik oftal’mologii 1998; 114(4): 3–8.
11. Volkov V.V., Dal’ G.A., Tulina V.M., Kulikov B.C., Gavrilova N.K., Nikolaenko V.P. Contusion ruptures of the eye capsule along the postoperative corneal-limbal scars. Vestnik oftal’mologii 1998; 114(2): 17–20.
12. Baudot A., Perone J.M., Agapie A., Lacusteanu M., Lasota P., Kurun S., Mnasri H., Bertaux P.J. Rupture of two radial keratotomy incisions 19 years later, during a clear corneal cataract surgery. Investigative Ophthalmology & Visual Science 2011; 52(14): 6221.
13. Behl S., Kothari K. Rupture of a radial keratotomy incision after 11 years during clear corneal phacoemulsification. J Cataract Refract Surg 2001; 27(7): 1132–1134, http://dx.doi.org/10.1016/S0886-3350(01)00763-5.
14. McNeill J.I. Corneal incision dehiscence during penetrating keratoplasty nine years after radial keratotomy. J Cataract Refract Surg 1993; 19(4): 542–543, http://dx.doi.org/10.1016/S0886-3350(13)80620-7.
15. Mac Rae S.M., Matsuda M., Rich L.F. The effect of radial keratotomy on the corneal endothelium. Am J Ophthalmol 1985; 100(4): 538–542, http://dx.doi.org/10.1016/0002-9394(85)90677-4.
16. Frueh B.E., Böhnke M. Endothelial changes following refractive surgery. J Cataract Refract Surg 1996; 22(4): 490–496, http://dx.doi.org/10.1016/S0886-3350(96)80048-4.
17. Surkova V.K., Shevchuk N.E., Pasikova N.V. Izmeritel’nyy instrument dlya rascheta parametrov khirurgicheskogo dostupa pri fakoemul’sifikatsii katarakty u patsientov posle radial’noy keratotomii [A measuring tool for calculation of surgical access paramertes in phacoemulcification of cataract in patients after radial keratotomy]. Patent RU 2552096. 2014.
18. Bikbov M.M., Bikbulatova A.A., Pasikova N.V. Retrospective analysis of the accuracy of IOL power calculation formulas after anterior radial keratotomy. Kataraktal’naya i refraktsionnaya khirurgiya 2015; 15(4): 26–29.

Pasikova N.V., Bikbulatova A.A., Bikbov M.M. Phacoemulsification of Cataract in Patients Undergone Anterior Radial Keratotomy. Sovremennye tehnologii v medicine 2016; 8(2): 66, https://doi.org/10.17691/stm2016.8.2.09