Radial Keratotomy Correction

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 Dr. Gulani has seen practically every possible pattern of Radial Keratotomy (RK) cases in his experience of correcting post RK Vision.

RK RK-AKRK Ruiz AKRK LassoRK HexKRK-LasikRK-ICL
          RK                      RK-AK                  RK Ruiz AK                RK-Lasso            RK-HexK                 RK-Lasik                  RK-ICL     
 
Radial Keratotomy is a surgery that was popular for correcting Nearsightedness before the advent of LASIK.
Popularized by a Russian ophthalmologist, Dr. Slava Fyodorov, it involved cutting the cornea with a diamond knife in making Radial Incisions to induce central flattening of the corneal curvature, thus correcting nearsightedness.
 
Many of these patients are presenting today to correct associated abnormalities, reverse vision disturbances and or enhance their vision.
 
Jacksonville, Fla., surgeon Dr. Arun Gulani has a worldwide referral base of such patients. He approaches such patients using his Corneoplastique™ concept that evaluates the patient’s “Five S’s”: sight; site affected; scar; stability and strength. “In the post-RK patient, he classifies the issues as follows:
 
“Gulani Classification” System for RK Cases:
 
Primary Visual factors:
Quantitative:
Decreased visual acuity (Myopia, Hyperopia, Astigmatism)
Qualitative
Irregular astigmatism
Small Optic Zone
Radial K Scars
Secondary (Associated) Visual Factors:
Presbyopia
Cataracts
Corneal Scars
Corneal Instability (thin / ectasia / trampoline effect)
 
 
 RK patients as we have seen uniquely vary by their number of incisions too:
 
         4 cut                            8 cut                        12 cut                       16 cut                         32 cut
 
Once the above is determined, the plan simply unfolds in front of your “Eyes”. The seemingly complex cornea now becomes a platform of visual rehabilitation along with if needed associated surgeries like cataract & IOL etc. This is what I call Refractive Surgery to the Rescue using the most accurate and elegant way to correct vision ie. Excimer Laser Surgery.
 
Depending on their presentation today, whether it be Nearsightedsness, Astigmatism, Farsightedness or Presbyopia, we can now correct them with Advanced Laser Vision Surgery.
If these patients need Cataract surgery (since they are now in the early cataract age group), Dr. Gulani recommends some pearls for eye surgeons about having to work on a post-RK eye:
 
1.       Select the site of entry based on astigmatism axis and available space between two radial incisions
2.       Low flow techniques.  Low flow phacoemulsification, Aqualase or phacochop techniques to keep the pressure in the eye down as you work
3.       Always remember that these patients were once myopic (nearsighted) in refraction (even though today they may present with farsightedness) and still have the myope’s ocular anatomy, so all the risks of cataract surgery in myopia [namely retinal issues] still apply.
 
Dr. Gulani has even used multifocal IOLs like the ReStor successfully in RK patients using his expertise in calculating post-refractive IOL powers.
 
Also, given his ability to peform the full range of Vision Corrective Procedures, he also performs Lens based (Cataract- Multiffocal Lens) surgery followed by Advanced Laser Surgery.

 
 
 
 
 
 
 
Recent References:
 
  • Gulani, AC. Laser Surgery in Post RK Cases: In Textbook: Surgical Techniques in Ophthalmology Refractive Surgery. JP Publishers 2009; 62:376-377
  • Gulani AC. Irregular Astigmatism: Management in Unstable Cornea Textbook of Irregular Astigmatism. Slack Inc. 2007; Slack Inc.
  • Gulani AC; McDonald M, Majmudar P, Koch D, Packer M, Waltz K. "Meeting the challenge of Post-RK patients”- Review of Ophthalmology, 2007; IV (10), 49-54.
  • Gulani AC. Corneoplastique™. Techniques in Ophthalmology 5(1):11-20, 2007
  • Gulani AC. “Corneoplastique” Video Journal of Cataract and Refractive Surgery. Vol XXII. Issue 3, 2006
  • Gulani AC, Alio J et al: “Abnormal Preoperative Topography in Refractive Surgery Complications: Cataract and Refractive Surgery Today Journal 2007; 7(2) 37-42
  • Gulani AC. "Como manejar logicamente a los pacientes post-lasik” Review of ophthalmology en Espanol., 2007; Edicion #19, 14-17.
  • Gulani AC. Pentacam Technology in Customized Refractive Surgery: In Textbook- Mastering the Techniques of Customized Lasik. J.P. Publishers 2007; 15, 156-164.
 
 


 

 

 

 

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