Overcorrected radial keratotomy treated with posterior chamber phakic intraocular lens and laser thermal keratoplasty.

ABSTRACT

PURPOSE: Modern refractive surgery is effective in a large majority of cases in achieving a good first time result. Some attempts at correction, however, are less successful and require subsequent revision. METHODS: A case of secondary hyperopic astigmatism (+0.75 +1.50 x 45 degrees) is reported in a patient who had undergone radial keratotomy for myopia of -6.00 +0.75 x 90 degrees, 8 years previously. Preoperative uncorrected visual acuity was 20/120 improving to 20/20 with correction. Further refractive procedures were performed including arcuate keratotomy, posterior chamber phakic intraocular lens implantation and laser thermal keratoplasty to improve the uncorrected visual result. RESULTS: Final uncorrected visual acuity was 20/40, spectacle-corrected visual acuity was 20/20 with a manifest refraction of +0.50 +1.00 x 40 degrees. CONCLUSIONS: This case demonstrates how the consecutive application of several procedures can successfully refine an initially unsatisfactory refractive result. The potential for reduced predictability and additional complications with each procedure should not be forgotten.