The Dry Eye Zone

Rebecca's Blog

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Case report: RK gone bad after 30 years later - back to 20/20 with sclerals

“Spontaneous corneal perforation” - ugh. Not a fun thing to undergo 30 years after a successful RK surgery (in 1985). After wearing a special soft lens for four months, the patient was able to get their vision back to 20/20 with a scleral lens.

I always wonder in these cases how the vision quality was and is. 20/whatever (high contrast visual acuity) only ever tells part of the story, after all.

Eye Contact Lens. 2018 Sep;44 Suppl 1:S341-S344. doi: 10.1097/ICL.0000000000000353.

A Case of Late Spontaneous Post-Radial Keratotomy Corneal Perforation Managed With Specialty Lenses.

Van den Heurck J, Boven K, Anthonissen L, Van Hoey M, Koppen C

Abstract

PURPOSE:

To describe a case of spontaneous wound dehiscence 29 years after radial keratotomy (RK) and to illustrate how specialty contact lenses were used for tectonic support and optic correction.

SETTING:

Tertiary referral center for corneal pathology.

DESIGN:

Case report.

RESULTS:

In November 2014, a 62-year-old woman presented to the emergency department with a spontaneous corneal perforation in her left eye. Her ocular history was significant only for uncomplicated RK surgery performed in 1985 to correct myopia (-5.50 D) in both eyes. At the slit-lamp pronounced, bullous edema was seen in the inferotemporal quadrant of the left cornea with internal opening of the 3.30- and 5-o'clock positions incisions and severe localized thinning and aqueous leakage at the 5-o'clock position incision. There was no history of trauma. A conservative approach was adopted: application of a standard bandage lens was effective in tamponading the leakage, allowing the anterior chamber to reform; a custom-made soft lens was worn for tectonic support over a period of 4 months. Finally, visual acuity was restored to 20/20-by fitting a scleral lens.

CONCLUSION:

Spontaneous corneal perforation is a rare but more dramatic long-term complication after RK. The pivotal role of appropriately fitted soft bandage lenses in the conservative management of this type of complex perforation is highlighted. For optical correction, a scleral lens was fitted with excellent visual result, illustrating the added value of specialty contact lenses as an alternative to surgery in the management of postrefractive corneas.