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Radial Keratotomy: a Review of 300 Cases Br J Ophthalmol: First Published As 10.1136/Bjo.76.10.586 on 1 October 1992

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Radial Keratotomy: a Review of 300 Cases Br J Ophthalmol: First Published As 10.1136/Bjo.76.10.586 on 1 October 1992 586 British JournalofOphthalmology 1992; 76: 586-589 Radial keratotomy: a review of 300 cases Br J Ophthalmol: first published as 10.1136/bjo.76.10.586 on 1 October 1992. Downloaded from A K Bates, S J Morgan, A D McG Steele Abstract were utilised depending on degree of myopia. Three hundred consecutive cases of radial Finally the incisions were carefully irrigated with keratotomy performed between 1985 and 1990 sterile saline, topical antibiotics were instilled, were reviewed. There were no sight and the eye was padded. threatening complications of surgery and no Postoperatively all patients received patient lost one or more lines of corrected prednisolone sodium drops 0 3% and chloram- Snelien acuity. Overall 78*7% saw 6/12 or phenicol drops four times daily for 4 weeks. better unaided postoperatively and 51*7% saw Patients were routinely reviewed at 2 and 6 6/6 or better. Refraction showed 61*3% to be weeks after surgery and then at 3, 6, 12, and 18 within 1 dioptre ofemmetropia and 86*7% were months. within 2 dioptres. Further analysis demon- strated that results of unaided acuity and proximity to emmetropia were much better for Results low (<-2.87 D) and moderate (-3.0 to -5*87 Three hundred procedures were performed on D) than for high (>-6-0 D) myopes. 169 patients ofwhom 100 were male. All were 21 (BrJ Ophthalmol 1992; 76: 586-589) years of age or older. The age of the patients at surgery is shown in Figure 1 and it may be seen that the majority fall within the 21-30 years age Currently myopia is being treated by radial group. Mean time of follow-up was 19 months keratotomy and by photorefractive keratectomy (range 12-60). using the excimer laser.' 2 In order to assess the Reasons for wanting surgery are shown in relative merits ofthese two techniques the results Figure 2. All patients were referred for surgery ofradial keratotomy from one surgical team were either directly by their general practitioners reviewed over a period of 5 years. (92 8%) or via other ophthalmologists (7 2%). Peroperative complications included 35 cases of single perforation and nine cases in which Method there were two perforations. All but two were The notes were reviewed of 300 consecutive Seidel negative on the morning after surgery, radial keratotomy procedures performed and these were negative by the following between 1985 and 1990 by one surgeon (AD morning. McG S) or directly under his auspices. http://bjo.bmj.com/ Preoperative assessment involved a full ophthalmic examination including mydriasis for fundal examination, confirmation of a stable refraction, and pachymetry. Each patient was thoroughly counselled and the controversial and unpredictable nature of this form of surgery explained. Details of the possible early and late on October 4, 2021 by guest. Protected copyright. postoperative complications were provided. All surgery was performed under general anaesthesia. The pupil was constricted pre- operatively. The selected size of central clear Moorfields Eye Hospital, City Road, London zone was delineated with a corneal marker fitted A K Bates with cross wires. Radial incisions were then S J Morgan made with a guarded knife set at 115% of the A D McG Steele measured central corneal thickness. Incisions Correspondence to: A K Bates. were made from the edge of the outer clear zone Accepted for publication to the periphery, leaving a small margin of uncut 8 April 1992 cornea at the limbus. Four or eight incisions 60 - Q Contact lens intolerance 50 -" 0 Spectacle intolerance ,-40 .0 * Occupation E 30- Cosmetic Z 20- 0 'Sport 10 * Other Figure I Age ofpatients at 21-25 26-30 31-35 36-4 41-45 46-50 51-55 time ofsurgery. Age (years) Figure 2 Reason givenfor wanting surgery. Radial keratotomy: a review of300 cases 587 Figure 3 Unaided visual 125 12 o Pre-op acuity before and after Br J Ophthalmol: first published as 10.1136/bjo.76.10.586 on 1 October 1992. Downloaded from surgery - allpatients. 100i Post-op -8 50) - X 75 0) .4 .0 E = 50 0._ . 0 z CL0 ,0 -4 25- 0~in nl -8 CF 3/60 6/60 6/366/24 6/18 6/12 6/9 6/6 6/5 6/4 -12 Visual acuity -12 -10 -8 -6 -4 -2 0 Pre-op (dioptres) Figure 5 Spherical equivalent before and after surgery - Only one late postoperative complication was individualpatients. recorded; a patient who developed a giant retinal tear 3 months after uneventful surgery which 2 dioptres of emmetropia declines across these was successfully treated. No other eye in the groups from 73-8% to 30 0% and from 93-8% to series lost one line of preoperative corrected 56-7% respectively (Table 2). Snellen acuity after surgery. In order to look at stability of refraction Figure 3 shows unaided Snellen visual acuity following surgery the spherical equivalent at the before and after surgery for all eyes. The values refraction nearest to 3 months after surgery was given here are from the patients' final follow-up compared with that at the final follow-up visit visit and this is the case for all results unless which was at a mean of 19 months and was always otherwise stated. Expressed figuratively 78-7% greater than 12 months (Fig 8). This shows that of patients saw 6/12 or better unaided post- 90% ofeyes change by 1 dioptre or less over this operatively and 51-7% saw 6/6 or better. time period and most less than 0 5 dioptre. Spherical equivalent before and after surgery The need for a spectacle correction fordistance is shown in Figure 4. Expressed figuratively vision, at final follow-up, was assessed. Sixty five 61-3% patients were within 1 dioptre of per cent were not wearing any correction, 30% emmetropia postoperatively and 86-7% were were wearing spectacles (although often only to within 2 dioptres. drive) and 5% were wearing contact lenses. In order to highlight individual variation in Recorded postoperative symptoms were also response to surgery Figure 5 shows individual analysed. The most common complaint at dis- plots of pre- and postoperative refractions. The charge was of diurnal variation in vision in 57 slope shows the no change line, with all those eyes. The other principal complaint was of glare above the line having a reduction in myopia. or 'starburst' effect in 13 eyes which was princi- This illustrates that the majority ofpatients with pally experienced when driving at night. How- preoperative values of -2 to -6 dioptres achieve ever in none of these patients were symptoms http://bjo.bmj.com/ results close to emmetropia. Predictability sufficiently bothersome to prevent them having appears to decline with increasing preoperative surgery on their second eye. myopia. To attempt to examine this more closely, eyes were divided into three groups. Low myopes from 0 to -2-87 dioptres, moderate Discussion from -3 00 to -5 87 Radial keratotomy has been performed at myopes dioptres, and high on October 4, 2021 by guest. Protected copyright. myopes ofgreater than -6 0 dioptres. Moorfields since 1981 and more than 600 Firstly, postoperative unaided acuity is shown procedures have been performed by one surgical for the three groups in Figure 6. It is clear that team. In this series we have reviewed the results predictability of outcome is much poorer in the from 300 consecutive procedures performed higher myopes and is best in the low group. This between 1985 and 1990. is presented in Table 1 and shows the highest The complication rate was low with no sight percentage of eyes achieving 6/12 and 6/6 in the threatening complications and no patient lost a low myopia group. The results are progressively line ofpreoperative corrected Snellen acuity as a poorer for the moderate and high myopia result ofsurgery. groups. This pattern is repeated with the results A large percentage of patients underwent of postoperative refraction (Fig 7). The predic- tability ofachieving a refractive result within 1 or a High group 50 >-6 D a Medium group 80 0 Pre-op -3 to -5-87 D 40 o Low group 4.0 0 to -2-87 D Q 30 60- o~~~~~~~Post-op 60 0 I 0. Ez40 LLLkkLIIIIi <6/60 6/60 6/36 6/24 6/18 6/12 6/9 6/6 6/5 Figure 4 Spherical equivalent before and after +3 +2 +1 +0 - -0 -1 -2 -3 -4 -5 -6 -7 Post-op unaided VA surgery - all patients. Spherical error (dioptres) Figure 6 Postoperative unaided visual acuity by groups. 588 Bates, Morgan, Steele Table I Postoperative unaided visual acuity by groups Table 2 Postoperative spherical equivalent by groups Low Mod High Low Mod High Br J Ophthalmol: first published as 10.1136/bjo.76.10.586 on 1 October 1992. Downloaded from % within 1 D of emtnetropia 73 8 56 5 30 0 % achieving 6/12 or better 89-2 76-5 40 0 % within 2 D ofemmetropia 93 8 86 5 56 7 % achieving 6/6 or better 64-6 46 5 10 0 surgery to meet the unaided visual requirements emmetropia. However the results from the high of a variety of occupations such as the armed myopia group were disappointing with only 40% forces, fire service, or prison service. Another achieving 6/12 or better and 57% within 2 large group were having difficulties with their dioptres of emmetropia. Other series have contact lenses and most of the remainder wished reported similar findings.3 to have surgery for cosmetic reasons (Fig 2). If myopia remains significantly under- In this series 80% saw 6/12 or better unaided corrected after surgery the question arises of postoperatively and 52% saw 6/6 or better (Fig when further surgery should be undertaken.
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