关键词: 白内障/外科学, 放射状角膜切开术

Abstract:

Objective To evaluate the efficacy and safety of phacoemulsification with 3.2 mm clear corneal incision for the cataract patients after radial keratotomy (RK). Design Retrospective cases series. Participants Patients with cataractous lens with previous RK 8 cases (13 eyes). In which, 2 cases (4 eyes) with 8 incisions RK, 3 cases (4 eyes) with 12 incisions RK and 3 cases (5 eyes) with 16 incision RK. Methods Phacoemulsification and IOL implantation was performed through 3.2 mm clear corneal incision by the same surgeon. In the 8 incisions RK group, the clear corneal incision was performed between the adjacent RK incisions without intersecting the RK incisions. In the 12 incisions RK group, the clear corneal incision intersected 1 RK incision. In the 16 incisions RK group, the clear corneal incision intersected 2 adjacent RK incisions. The condition of RK incisions, management of complications and postoperative visual acuity was observed at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, 2 years and 3 years after the surgery. Main Outcome Measures Presence or absence of RK incision dehiscence during or after the surgery, postoperative best-corrected visual acuity (BCVA), corneal astigmatism, and corneal endothelial cell density. Results No RK incision dehiscence noted in all the 8 and 12 RK incisions groups and the clear corneal incisions were well apposed. Dehiscence was noted in one of the adjacent RK incisions in 2 eyes of the 16 RK incisions group. The dehiscences of RK incisions were closed by injecting air bubble with and without viscoelastic agent into the anterior chamber. During the follow-up, the incisions were well apposed in all of the 13 eyes and no new dehiscence of RK incisions occurred. In the last follow-up, the mean of BCVA (0.67±0.18) was better than preoperative BCVA（0.29±0.20）(t=-6.077, P=0.000); There was no significant difference between the final postoperative (1.69 ± 1.23 D) and preoperative corneal astigmatism (1.69±1.23 D)(t=-0.758, P= 0.470); while the mean postoperative corneal endothelial cell density (1716.95±906.79/mm2) was significantly less than the mean preoperative corneal endothelial cell density(2383.97±833.39/mm2) (t=2.995, P=0.012). Conclusion Phacoemulsification and IOL implantation with a 3.2 mm clear corneal incision in eyes with previous 8 and 12 incisions RK is safe. While a manageable dehiscence is possible to occur in eyes with previous 16 RK incisions, it suggests the smaller clear corneal incision or scleral tunnel incision should be used in eyes with 16 RK incisions.

Key words: cataract/surgery, radial keratotomy