Sequential Customized Therapeutic Keratectomy In Patients With A History Of Radial Keratotomy

To evaluate the outcome of sequential customized therapeutic keratectomy (SCTK) in reducing high order aberrations (HOAs) and improving quality of vision in highly aberrated corneas consequent to previous radial keratotomy (RK).

Retrospective analysis of patients undergoing SCTK treatment from January 2012 to October 2020 was performed. Indications for treatment in RK patients were significantly and/or progressively reduced corrected distance visual acuity (CDVA) combined with visual symptoms critically affecting quality of life. Preoperatively and postoperatively CDVA, corneal topography and aberrometry, Scheimpflug tomography and anterior segment optical coherence tomography were registered.

Thirty-four patients who underwent RK a mean of 26.62 ± 7.10 years before SCTK treatment were included. SCTK induced a significant improvement of CDVA from 0.44 ± 0.82 logMAR preop to 0.15 ± 0.64 logMAR postop (p <0.001) with a median follow up of 7 (IQR = 13.5) months. No patient experienced worsening of CDVA while 8 patients (23,50%) manifested gain of 1 line and 23 patients (67.65%) experienced a gain of 2 lines or more. A significant decrease in corneal coma, trefoil and spherical aberrations was also noted (respectively p = 0.003, p = 0.003, p = 0.004).

SCTK proved to be a safe and effective option to treat highly aberrated eyes following RK. We suggest the use of SCTK as first-line approach for the treatment of HOA after RK and avoiding more invasive procedure such as corneal transplant.