This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such, she had 20 cuts of radial keratotomy (RK) in the cornea in order to induce enough flattening to result in an emmetropic outcome. This worked reasonably for many years, but over time she slowly became hyperopic and then developed a cataract. Doing cataract surgery in this eye will not be routine: there are challenges in both the lens power estimation as well as in the intra-operative surgical technique.

Radial Keratotomy (RK) is an antiquated technique for the most part and it is no longer routinely performed. First started doing ocular surgery more than 20 years ago and I have never performed an RK procedure, so it has been decades since it was routinely done in the United States. Since most RK patients had the surgery done to their eyes about 30 years ago, these same patients are now entering the age where cataracts naturally develop. In their careers, all ophthalmologists are expected to encounter multiple RK patients who now need cataract surgery.

The primary issues intra-operatively are avoiding the RK with your cataract surgery incisions and ensuring that these RK cuts do not leak during the procedure. For patients with 4, 6, or 8-cut RK, the phaco incisions can be placed at the limbus-cornea edge with care taken not to intersect the RK cuts. For those with 12, 16, or 20-cut RK, the best option is to avoid the cornea and make a scleral tunnel incision instead. This scleral tunnel can be made superiorly or temporally and it should be sutured for maximum stability.

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