Robert H. Bedrossian

Diurnal Variation in Vision After Radial Keratotomy

We tested eight patients who had undergone radial keratotomy with regard to refraction, keratometry, corneal thickness, and intraocular pressure one to two weeks after surgery. Patients were examined immediately after eye-lid opening at 7:30 A.M. and again at 4:00 P.M. The contralateral eye was used as a control. The treated eye was 1.48 +/- 0.24 diopters (mean +/- S.E.M.) more hyperopic at the morning examination compared to the afternoon visit, whereas the control eye had an insignificant shift (0.16 +/- 0.06 diopters). The treated eye was significantly flatter (1.37 +/- 0.19 diopters) in the morning than in the afternoon when compared to the control eyes, which were only 0.11 +/- 0.09 diopter flatter. The intraocular pressure changed insignificantly in both the treated and control eyes (-0.5 +/- 0.53 mm Hg and -0.5 +/- 0.84 mm Hg, respectively). The mean morning corneal thickness was significantly greater (5.7%) than the afternoon thickness when compared to the controls (1.7% morning increase in thickness). These data suggest that diurnal variation in corneal thickness after radial keratotomy plays a role in diurnal variation of vision in the early postoperative period.

The treatment of persistent wound leak after radial keratotomy

BACKGROUND Macroperforation of the cornea during refractive keratotomy can result in persistent wound leak and may need treatment by suturing. METHODS We describe two eyes that developed a macroperforation during radial keratotomy with persistent leakage of aqueous. The wounds were sutured with 10-0 and 11-0 nylon sutures. RESULTS The sutures induced irregular astigmatism as shown by corneal topography. Removal of sutures improved the topography and led to an acceptable outcome. CONCLUSION Macroperforations with persistent aqueous leaks should be sutured. Suture removal within a few weeks after surgery can avoid persistent irregular astigmatism and lead to a good refractive result.