The Dry Eye Zone

Rebecca's Blog


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



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.


Tertiary referral center for corneal pathology.


Case report.


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.


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.