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Lasik After Radial Keratotomy (RK)

Issues with RK and Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, P-IOL, RLE, Intacs, etc.


Close image of cornea with RK incisions.  
RK incisions create a special challenge for Lasik, but correction is possible.  
   

It is often possible to have custom wavefront Lasik, Bladeless Lasik, or other refractive surgery procedures if you have had Radial Kertotomy (RK) in the past, but success will be limited by many factors.

Fluctuation

RK patients often have corneas that are weakened and fluctuate throughout the day, causing difficulty with glasses fitting. Corneas that are unstable should probably not have additional refractive surgery. Cornea stability needs to to be addressed before considering any additional cornea surgery. For details, read RK Fluctuation and Hyperopic Shift

Shift Toward Farsighted Vision

Many RK patients who were previously myopic (nearsighted, shortsighted) and corrected to plano at the time of their surgery are becoming hyperopic (farsighted, longsighted) due to a shift of the cornea. This hyperopic shift is apparently cause by progressive weakening of the cornea.

Over Age 40: Presbyopic and Farsighted

As adults pass the age of about 40 they become presbyopic and are unable to achieve clear near vision. If the patient is both hyperopic and presbyopic, they are likely to have poor vision at most distances. These patients often seek additional surgery to correct their poor vision due to presbyopia, however there are no safe, reliable, and predictable ways to "cure" presbyopia with surgery. It may be possible to correct underlying hyperopia, which exacerbates presbyopia, if the cornea is relatively stable or if the cornea can be stabilized with treatment. Monovision correction is a workaround for some presbyopic patients.

Corneal Irregularities

Patients with previous RK may have irregular astigmatism that is difficult to impossible to correct with current laser technology and techniques. If the irregularities are too great, wavefront-guided ablation may be impossible or unwise. Conventional ablation or even C-CAP may be necessary. Although possibly difficult, irregular astigmatism may be improved with Lasik, Bladeless Lasik, etc.

Contacts First

Probably the first method of correction for RK patients with previous RK should be Rigid Gas Permeable (RGP) contact lenses. RGPs are a stabilizing force for the cornea and correct refractive error. RGPs improve an irregular cornea by applying a smooth and rigid surface while "squishing" down the irregularities and smoothing outer surface of the cornea. Often RGPs provide the stability needed for good correction.

Surface Ablation or Intacs

Although conventional or custom wavefront Lasik is often performed for previous RK patients, the condition of the cornea must be very carefully examined. RK makes deep radial incisions into the cornea. When the Lasik flap is created, it can fall apart like so many pieces of a pizza. For this reason, it is often more safe for previous RK patients to consider a surface ablation techniques PRK or LASEK. The use of Intacs may be best suited as Intacs tend to stabilize a fluctuating cornea. In some instances a combination of Intacs and surface ablation may be appropriate. Epi-Lasik is also a surface ablation technique, but cannot be safely performed on patients with previous RK.

Lens Based Surgery

If the cornea is too weakened by previous surgery, it may be appropriate to consider lens-based surgery such as RLE or P-IOL. These techniques will not resolve fluctuations or corneal irregularities, however they can be appropriate techniques to resolve some refractive errors. Intraocular lenses used for RLE may be multifocal or self accommodating to lower the effects of presbyopia. Learn more about presbyopia surgery.

CxL CrossLinking Stiffening

A developing technique of stabilizing the cornea is Corneal Collagen Crosslinking with Riboflavin (CxL). This process uses high frequency light with the eyes protected with a riboflavin solution to cause a stiffening of the cornea. CrossLinking can be used in combination with other techniques, such as Intacs.

Not every refractive surgeon will perform new refractive procedures on RK recipients. Be sure you select a doctor who has this experience.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.


Recent Lasik After RK Medical Journal Articles...

Related Articles

Localized midperipheral corneal steepening after hyperopic LASIK following radial keratotomy.

Cornea. 2003 Oct;22(7):679-83

Authors: Chan CC, Rootman DS

Abstract
PURPOSE: To describe a case of localized midperipheral corneal steepening after laser in situ keratomileusis (LASIK) to correct hyperopia induced by radial keratotomy (RK) overcorrection.
METHODS: A retrospective case observation of an unusual case.
RESULTS: Five years after bilateral RK (with eight incisions) performed out of the country, a 43-year-old woman underwent LASIK in her right eye. Preoperatively, manifest refraction was + 7.75 - 1.00 x 104. Four months after LASIK, the patient's UCVA was 20/70, manifest refraction was + 2.25 - 1.25 x 103, and LASIK enhancement with flap recutting was performed. One month later, the patient complained of a 1-day history of pain and photophobia. UCVA was 20/40, and a RK incision had opened. The eye was covered with a bandage contact lens (BCL) and TobraDex drops prescribed. The following day, the BCL was removed, and UCVA was 20/200. Four days later, the patient's UCVA was 20/25. Five and a half months after LASIK enhancement, the dehisced RK incision was closed, UCVA was 20/30, and manifest refraction was + 1.25 - 1.25 x 85. One year after enhancement, UCVA deteriorated to 20/70 with manifest refraction of - 1.00 - 1.25 x 40. Localized midperipheral corneal steepening on topography also seemed to be developing.
CONCLUSION: In LASIK surgery after RK, there is an inherent weakness of the cornea. Although visual acuity after RK-induced hyperopia may be improved by LASIK, the long-term refractive stability of the procedure is uncertain. Patients who undergo such a procedure should be monitored for developing localized midperipheral corneal steepening and be informed that such a complication can occur.

PMID: 14508265 [PubMed - indexed for MEDLINE]

 


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