• My Dashboard My Education Find an Ophthalmologist
  • Home
  • Coronavirus
  • For Ophthalmologists
    • Meetings
      • AAO 2022
        • Meeting Information
          • Past and Future Meetings
          • Mobile Meeting Guide
          • Contact Information
          • Annual Meeting News
          • Health and Safety
          • Policies and Disclaimers
        • Program
          • Program Highlights
          • Subspecialty Day
          • Virtual Meeting
          • Program Committees
          • CME
          • Meeting Archives
        • Expo
        • Registration
        • Hotels & Travel
          • Hotel Reservation Information
          • Chicago
          • International Attendees
          • Hotel Meeting Space
        • Presenter Central
          • Presenter Central
          • Abstract Selection Process
          • Submission Policies
          • Subject Classification/Topics
          • Instruction Courses and Skills Transfer Labs
          • Papers and Posters
          • Videos
          • Grand Rounds Symposium
          • Program Participant and Faculty Guidelines
          • Faculty Development Program
        • Exhibitors
          • Exhibitor Central
          • Exhibitor Portal Information
          • Exhibitor Prospectus
          • New Exhibiting Companies
          • Exhibitor Resources
          • International Exhibitors
          • Promotional Opportunities
          • Exhibitor Hotel Reservations
      • Mid-Year Forum
        • Registration and Travel
        • Congressional Advocacy Day
        • Advocacy Ambassador Program
        • Program
        • Schedule
        • Sponsored Attendees
        • News
      • Codequest
        • Codequest Instructors
        • Claim Codequest CME or CEU Credit
      • Eyecelerator
    • Clinical Education
      • COVID-19
      • Education
        • Browse All Education
        • Courses
        • Cases
        • Learning Plans
        • Interactive
        • Focal Points
        • Wills Eye Manual
        • Disease Reviews
        • Clinical Webinars
        • Diagnose This
        • Self-Assessments
        • Educational Centers
          • Glaucoma Education Center
          • Pediatric Ophthalmology Education Center
          • Laser Surgery Education Center
          • Myopia Resources
          • Oculofacial Plastic Surgery Center
          • Redmond Ethics Center
      • Journals
      • Guidelines
        • Browse All Practice Guidelines
        • Preferred Practice Patterns
        • Clinical Statements
        • Compendium Guidelines
        • Complementary Therapy Assessments
        • Medical Information Technology
        • Ophthalmic Technology Assessments
        • Patient Safety Statements
        • Choosing Wisely
        • Low Vision
        • Eye Care for Older Adults
        • Eye Disease Statistics
        • About the Hoskins Center
      • Video and Image Library
        • Browse All Videos
        • Clinical and Surgical Videos
        • Presentations and Lectures
        • 1-Minute Videos
        • Master Class Videos
        • Basic Skills Videos
        • Interviews
        • Images
        • Submit an Image
        • Submit a Video
      • Podcasts
        • Browse All Audio and Podcasts
        • Experts InSight
        • Ophthalmology Journal
      • News
        • Browse All Clinical News
        • Editors' Choice
        • Headlines
        • Current Insight
      • CME Central
        • Browse All CME Activities
        • Claim CME Credit and View Transcript
        • CME Planning Resources
        • Complete Your Financial Disclosure
        • Joint Sponsorship Portal
        • LEO Continuing Education Recognition Award
        • Safe ER/LA Opioid Prescribing
        • Check Your Industry Payment Records
      • MOC
      • Resident Education
        • Resident Education Home
        • Browse All Resident Content
          • Courses
          • Flashcards
          • Interactive Cases and Simulations
          • Videos
          • Webinars
        • OKAP and Board Exam Resources
          • OKAP Exam
          • Board Prep Resources
          • OKAP and Board Review Presentations
          • Study Flashcards
        • Cataract Master
        • Diversity and Inclusion Education
        • News and Advice from YO Info
        • Pediatric Ophthalmology Education Center
        • PGY-1 and PGY-2 Resources
        • Simulation in Resident Education
    • Membership
      • Join
      • Renew
      • Current Member
      • Volunteer
      • Physician Wellness
      • Member Directory
      • Member Obituaries
      • AAOE Membership
    • Advocacy
      • Advocacy News
      • Get Involved
        • Ways to Give
        • How to Get Involved
        • Congressional Advocacy
        • Support the Academy's Agenda
        • Research Legislation
        • Find Your Legislators
        • I Am an Advocate
        • Advocacy at Home
        • Advocate Tools
        • Best Practices for Advocating at Home
        • Social Media Toolkit
        • Letter to Editor
        • Town Hall Guide
        • Guide to Engaging With New Lawmakers
        • Resources
        • Attending a Political Fundraiser
      • OPHTHPAC
        • About Us
        • Join OPHTHPAC
        • OPHTHPAC Blog
      • Surgical Scope Fund
        • Support Surgery By Surgeons
        • Surgery By Surgeons Blog
    • Publications
      • EyeNet Magazine
        • Latest Issue
        • Archive
        • Subscribe
        • Advertise
        • Write For Us
        • Corporate Lunches
        • Contact
        • MIPS 2022
      • Focal Points
      • Ophthalmology
      • Ophthalmology Glaucoma
      • Ophthalmology Retina
      • YO Info
      • Scope
    • Subspecialties
      • Cataract/Anterior Segment
      • Comprehensive Ophthalmology
      • Cornea/External Disease
      • Glaucoma
      • Neuro-Ophthalmology/Orbit
      • Ocular Pathology/Oncology
      • Oculoplastics/Orbit
      • Pediatric Ophthalmology/Strabismus
      • Refractive Management/Intervention
      • Retina/Vitreous
      • Uveitis
    • IRIS Registry
      • About
      • Using the Registry
        • User Guide
        • Medicare Reporting
        • Maintenance of Certification
        • Non-EHR Reporting
      • Sign Up
        • Application Process
        • Why Participate
        • Once You've Applied: Getting Started
        • What Practices Are Saying About the Registry
      • Requirements
        • EHR Systems
        • Data & Technical Needs
      • Research
      • Registry Dashboard
      • News
      • Medicare & MIPS
    • Medicare Information
    • Diversity, Equity, and Inclusion
  • For Practice Management
    • Managing Your Practice
      • Managing Your Practice Topics
      • Coronavirus Resources
      • Reopening & Recovery
      • Practice Forms Library
      • Practice Management News and Advice
      • AAOE-Talk
      • Video Library
      • Ophthalmology Job Center
      • Benchmarking and Salary Tools
      • Academy Consultations
      • Consultant Directory
    • Coding
      • Coding Topics
      • Codequest Events
      • Ask the Coding Experts
      • Coding Updates and Resources
      • Coding for Injectable Drugs
      • EM Documentation
      • ICD-10-CM
      • Ophthalmic Coding Specialist (OCS) Exam
      • Retina
      • Savvy Coder
    • Webinars and Events
      • Annual Meeting
      • Codequest Courses
      • Mid-Year Forum
      • Webinar Recordings
    • IRIS Registry
      • Merit-Based Incentive Payment
    • Medicare and MIPS
      • MIPS
        • Quality
        • Promoting Interoperability
        • Improvement Activities
        • Cost
        • Avoid a Penalty
      • Resources
      • Medicare Participation Options
      • Medicare Advantage Plans
      • New Medicare Card
      • Provider Enrollment, Chain and Ownership System (PECOS)
    • Regulatory Compliance
      • HIPPA Resources
      • Office of Inspector General
      • Audits
      • OSHA
    • AAOE Membership
      • Join AAOE
      • Membership Benefits
      • Renew/Pay Dues
    • About AAOE
      • AAOE Board of Directors
      • AAOE Content Committee
      • Volunteer Opportunities
  • For Public & Patients
    • Eye Health A-Z
    • Symptoms
    • Glasses & Contacts
    • Tips & Prevention
    • News
    • Ask an Ophthalmologist
    • Patient Stories
    • No Cost Eye Exams
    • Español
      • A - Z de Salud Ocular
      • Síntomas
      • Anteojos y Lentes de Contacto
      • Consejos y Prevención
      • Noticias
      • Relatos de Pacientes
      • Exámenes de la vista sin costo
      • English
  • AAO 2022
    • Meeting Information
      • Past and Future Meetings
      • Mobile Meeting Guide
      • Contact Information
      • Annual Meeting News
      • Health and Safety
      • Policies and Disclaimers
    • Program
      • Program Highlights
      • Subspecialty Day
      • Virtual Meeting
      • Program Committees
      • CME
      • Meeting Archives
    • Expo
    • Registration
    • Hotels & Travel
      • Hotel Reservation Information
      • Chicago
      • International Attendees
      • Hotel Meeting Space
    • Presenter Central
      • Presenter Central
      • Abstract Selection Process
      • Submission Policies
      • Subject Classification/Topics
      • Instruction Courses and Skills Transfer Labs
      • Papers and Posters
      • Videos
      • Grand Rounds Symposium
      • Program Participant and Faculty Guidelines
      • Faculty Development Program
    • Exhibitors
      • Exhibitor Central
      • Exhibitor Portal Information
      • Exhibitor Prospectus
      • New Exhibiting Companies
      • Exhibitor Resources
      • International Exhibitors
      • Promotional Opportunities
      • Exhibitor Hotel Reservations
  • About
    • Who We Are
      • What We Do
      • About Ophthalmology
      • The Eye Care Team
      • Ethics and the Academy
      • History
      • Museum of Vision
      • Values
    • Governance
      • Council
      • Board of Trustees
      • Committees
      • Academy Past Presidents
      • Secretariats
      • Elections
      • Academy Blog
      • Academy Staff Leadership
    • Leadership Development
    • Awards
      • Laureate Recognition Award
      • Outstanding Advocate Award
      • Outstanding Humanitarian Service Award
      • International Blindness Prevention Award
      • Distinguished Service Award
      • Guests of Honor
      • Secretariat Award
      • Straatsma Award
      • Achievement Award Program
      • Artemis Award
      • EnergEYES Award
      • International Education Award
      • International Scholar Award
      • Commitment to Advocacy Award
      • Visionary Society Award
    • Financial Relationships
    • Policy Statements
    • Related Organizations
      • Subspecialty/Specialized Interest Society Directory
      • State Society Directory
      • Subspecialty/Specialized Interest Society Meetings
      • State Society Meetings
      • Resources for Societies
    • Year in Review
      • 2020 Year in Review
  • Foundation
    • About
      • 2020-2021 Annual Report
      • Annual Report Archives
      • News From the Chair
      • Foundation Staff
    • Our Impact
      • Partners for Sight
      • Donor Spotlights
      • Global Ophthalmic Community
      • Sponsorships
      • Patients and the Public
    • Giving Options
      • Our Supporters
      • Estate and Planned Giving
      • Ophthalmic Business Council
      • Parke Center Campaign
      • Minority Ophthalmology Mentoring Campaign
      • Museum of the Eye Campaign
    • Orbital Gala
      • Why Attend
      • Photo Recap
      • Corporate Support Opportunities
      • Tribute Gifts
      • Silent Auction
      • Corporate Sponsors
    • Donate
    • Museum of the Eye Campaign
      • Museum Supporters
  • Museum of the Eye
    • Visit
    • What's On
      • Museum Galleries
      • Special Exhibitions
      • Current Events
      • Past Events
    • Explore
      • Research and Resources
      • Collection Search
      • Previous Exhibits
      • Oral Histories
      • Biographies
    • Volunteer
    • Mailing List
    • Donate
    • About the Museum
      • Museum Blog
  • Young Ophthalmologists
    • YO Info
    • Learn to Bill
    • Engage with the Academy
  • Senior Ophthalmologists
    • Scope
    • Practice Transitions
  • International Ophthalmologists
    • Global Programs and Resources for National Societies
    • Awards
    • Global Outreach
  • Residents
  • Medical Students
×
Shop
Log In Create an Account
  • For Ophthalmologists
  • For Practice Management
  • For Public & Patients
  • Coronavirus
  • About
  • Foundation
  • Museum of the Eye
  • COVID-19
  • Journals
  • Education
    • Education
    • Courses
    • Cases
    • Learning Plans
    • Interactive
    • Focal Points
    • Wills Eye Manual
    • Disease Reviews
    • Clinical Webinars
    • Diagnose This
    • Self-Assessments
    • Education Centers
      • Glaucoma Education Center
      • Pediatric Ophthalmology Education Center
      • Laser Surgery Education Center
      • Oculofacial Plastic Surgery Center
      • Redmond Ethics Center
      • Myopia Resources
      • Thyroid Eye Disease Resources
  • Guidelines
    • Practice Guidelines
    • Preferred Practice Patterns
    • Clinical Statements
    • Ophthalmic Technology Assessments
    • Patient Safety Statements
    • Complementary Therapy Assessments
    • Compendium Guidelines
    • Medical Information Technology
    • Low Vision
    • Choosing Wisely
    • Eye Care for Older Adults
    • Eye Disease Statistics
    • About the Hoskins Center
    • Artificial Intelligence
    • Premium IOLs
    • Patient-Reported Outcomes with LASIK Symptoms and Satisfaction
  • Multimedia
    • Multimedia Library
    • Video
      • 1-Minute Videos
      • Presentations and Lectures
      • Master Class Videos
      • Basic Skills Videos
      • Clinical and Surgical Videos
      • Interviews
      • Resident Lectures
      • Submit a Video
      • YO Video Contest
    • Podcasts
      • Browse Podcast Archive
      • Experts InSight Podcast
      • Ophthalmology Journal Podcast
    • Images
      • Submit an Image
  • News
    • Clinical News
    • Editors' Choice
    • Headlines
    • Current Insight
  • CME
    • CME Central
    • Claim CME Credit and View Transcript
    • CME Planning Resources
    • Complete Your Financial Disclosure
    • Joint Sponsorship Portal
    • LEO Continuing Education Recognition Award
    • Safe ER/LA Opioid Prescribing
    • Check Your Industry Payment Records
  • MOC
  • Residents
    • Resident Education Home
    • Browse All Resident Content
      • Courses
      • Flashcards and Study Presentations
      • Interactive Cases and Simulations
      • Videos
      • Webinars
    • Cataract Master
    • Diversity and Inclusion Education
    • News and Advice from YO Info
    • OKAP and Board Exam Resources
      • OKAP Exam
      • Board Prep Resources
      • OKAP and Board Review Presentations
      • Study Flashcards
    • Pediatric Ophthalmology Education Center
    • PGY-1 and PGY-2 Resources
    • Resident Knowledge Exchange
    • Simulation in Resident Education
    • Clinical Education /
    • Book Excerpts /
    • Basic and Clinical Science Course - Excerpt
  • 2020–2021 BCSC Basic and Clinical Science Course™

    Go to Academy Store Learn more and Purchase.

    13 Refractive Surgery

    Chapter 3: Incisional Corneal Surgery

    This chapter includes a related video, which can be accessed by scanning the QR code provided in the text or going to www.aao.org/bcscvideo_section13.

    Incisional refractive surgery for treatment of myopia has largely been replaced by other modalities, but is still used for treatment of primary astigmatism during cataract surgery and residual astigmatism after both cataract and keratorefractive surgery (limbal relaxing incisions) and following penetrating keratoplasty (arcuate keratotomy). In fact, the use of incisional surgery, both traditional and intrastromal, has increased significantly with the advent of refractive cataract surgery utilizing femtosecond laser platforms and multifocal lens implants.

    The history of incisional keratotomy dates back to the 1890s. Lans examined astigmatic changes induced in rabbits after partial-thickness corneal incisions and thermal cautery. Sato made significant contributions to incisional refractive surgery in the 1930s and 1940s. He observed central corneal flattening and improvement in vision after the healing of spontaneous ruptures of the Descemet membrane (corneal hydrops) in patients with advanced keratoconus, which led him to develop a technique to induce artificial ruptures of the Descemet membrane. His long-term results in humans were poor, because incisions were made posteriorly through the Descemet layer, leading to endothelial cell failure and corneal edema in 75% of patients. In the 1960s and 1970s, Fyodorov, using radial incisions on the anterior cornea, established that the diameter of the central optical clear zone was inversely related to the amount of refractive correction: smaller central clear zones yield greater myopic corrections.

    Incisional Correction of Myopia

    Radial Keratotomy in the United States

    Radial keratotomy (RK) is now largely considered an obsolete procedure, but it did play an important role in the history of refractive surgery. RK differs from surface ablation/ photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in that it does not involve removal of tissue from the central cornea; rather, there is a redistribution of power from the center to the periphery.

    To evaluate the safety and efficacy of RK, the Prospective Evaluation of Radial Keratotomy (PERK) study was undertaken in 1982 for patients with myopia from –2.00 D to –8.75 D (mean, –3.875 D). The sole surgical variable was the diameter of the central optical clear zone (3.00, 3.50, or 4.00 mm), based on the level of preoperative myopia. Ten years after the procedure, 53% of the 435 study patients had 20/20 or better uncorrected visual acuity (UCVA; also called uncorrected distance visual acuity, UDVA) and 85% had 20/40 or better. In addition, the older the patient, the greater the effect achieved with the same surgical technique. The most important finding in the 10-year PERK study was the continuing long-term instability of the procedure. A hyperopic shift of 1.00 D or greater was found in 43% of eyes between 6 months and 10 years postoperatively.

    • Waring GO III, Lynn MJ, McDonnell PJ; PERK Study Group. Results of the Prospective Evaluation of Radial Keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol. 1994;112(10):1298–1308.

    Surgical technique

    Radial corneal incisions sever collagen fibrils in the corneal stroma. This produces a wound gape with midperipheral bulging of the cornea, compensatory central corneal flattening, and decreased refractive power, thereby decreasing myopia (Fig 3-1).

    The design of the diamond-blade knife (angle and sharpness of cutting edge, width of blade, and design of footplate) influenced both the depth and the contour of incisions. The ideal depth of RK incisions is 85%–90% of the corneal thickness.

    Postoperative refraction, visual acuity, and corneal topography

    Radial keratotomy changes not only the curvature of the central cornea but also its overall topography, creating an oblate cornea—flatter in the center and steeper in the periphery. The procedure reduces myopia but increases spherical aberration. The result is less correlation among refraction, central keratometry, and UCVA, presumably because the new corneal curvature creates a more complex, multifocal optical system. The effect is that keratometric readings, which sample a limited number of points approximately 3.0 mm apart, might show degrees of astigmatism that differ from those detected by refraction. Also, central corneal flattening affects intraocular lens (IOL) power calculations for cataract surgery (discussed later in this chapter and in Chapter 11).

    Figure 3-1 Schematic diagrams of the effect of radial incisions. A, 8-incision radial keratotomy (RK) with circular central optical zone (dashed circle), which shows the limit of the inner incision length. B, Cross-sectional view of the cornea, pre-RK.C, After RK the corneal periphery is steepened and the center flattens. Flattening is induced in the central cornea.

    (Modified from Troutman RC, Buzard KA. Corneal Astigmatism: Etiology, Prevention, and Management. St Louis: Mosby-Year Book; 1992.)

    Stability of refraction

    Most eyes were generally stable by 3 months after RK surgery. However, diurnal fluctuation of vision and a progressive flattening effect after surgery have been known to persist, resulting in refractive instability.

    Diurnal fluctuation of vision occurs due to hypoxic edema of the incisions with the eyelids closed during sleep. This edema causes flattening of the cornea (and hyperopic shift) upon awakening, followed by steepening later in the day. In a subset of the PERK study at 10 years, the mean change in the spherical equivalent of refraction between the morning (waking) and evening examinations was an increase of 0.31 ± 0.58 D in minus power.

    The progressive flattening effect of surgery was one of the major untoward results described in the PERK study. Greater hyperopic shift was noted with smaller optical zones. The potential stabilizing effect of corneal crosslinking (CCL) is currently being studied.

    • Elbaz U, Yeung SN, Ziai S, Lichtinger AD, et al. Collagen crosslinking after radial keratotomy. Cornea. 2014;33(2):131–136.

    • Mazzotta C, Baiocchi S, Denaro R, Tosi GM, Caporossi T. Corneal collagen cross-linking to stop corneal ectasia exacerbated by radial keratotomy. Cornea. 2011;30(2):225–228.

    Complications

    After RK surgery, 1%–3% of eyes experienced loss of 2 or more lines of Snellen visual acuity. This effect was due to induction of irregular astigmatism from hypertrophic scarring, intersecting radial and transverse incisions (Fig 3-2), and central clear zones smaller than 3.0 mm.

    Many patients reported the appearance of starburst, glare, or halo effects around lights at night after RK. Treatment with drugs that promote pupillary constriction, such as pilocarpine, or decrease pupillary dilation, such as brimonidine may be able to reduce symptoms by keeping the pupillary diameter within the central optical clear zone. Other complications included fluctuation in vision and loss of best-corrected visual acuity (BCVA; also called corrected distance visual acuity, CDVA), induced astigmatism due to epithelial plugs and wound gape (see Fig 3-2), vascularization of stromal scars, and nonprogressive endothelial disruption beneath the incisions.

    Figure 3-2 A, Crossed RK and arcuate keratotomy incisions with epithelial plugs in a patient who had intraoperative corneal perforation. B, Fluorescein study demonstrates gaping of the incisions, causing persistent ocular irritation.

    (Courtesy of Jayne S. Weiss, MD.)

    Potentially blinding complications occurred only rarely after RK. These included perforation of the cornea, which can lead to endophthalmitis, epithelial downgrowth, and traumatic cataract. The postoperative use of contact lenses often resulted in vascularization of the incisions, with subsequent scarring and irregular astigmatism. Radial keratotomy incisions remain a point of weakness, and rupture of RK wounds secondary to blunt trauma has been reported up to 13 years after the procedure.

    Ocular surgery after radial keratotomy

    It is not uncommon for RK patients to present years later with hyperopia. LASIK and PRK have been shown to be effective in correcting hyperopia and myopia after RK. However, surface ablation may be preferred, as creation of a LASIK flap may result in irregular astigmatism, splaying of the incisions, epithelial ingrowth, as well as loss of sections of the flap, which can be challenging to treat. Surface ablation avoids the LASIK-related risks after RK but increases the risk of postoperative corneal haze. The off-label use (in the United States) of mitomycin C, 0.02% (0.2 mg/mL) applied to the stroma after laser ablation for 12–30 seconds, has dramatically reduced corneal haze after RK and other prior corneal surgical procedures (eg, corneal transplant and LASIK). The drug should be copiously irrigated from the eye so that toxic effects are reduced.

    Patients undergoing laser vision correction for refractive errors after RK need to understand that laser correction will not remove scars caused by RK incisions, so glare or fluctuation symptoms may remain after the laser surgery. In addition, some patients may still experience continued hyperopic progression.

    In patients with endothelial dystrophy, corneal infection, irregular astigmatism, severe visual fluctuations, or starburst effects, keratoplasty may be needed to restore visual functioning. It should be avoided if the patient’s visual problems can be corrected with glasses or contact lenses (see the section Corneal Transplantation After Refractive Surgery in Chapter 11). If keratoplasty is deemed necessary, before trephination the RK incisions may need to be stabilized with sutures outside the trephine cut. This minimizes the chance of their opening and allows adequate suturing of the donor corneal graft to the recipient bed.

    Cataract extraction with IOL implantation may lead to variable results after RK. In the early postoperative period, corneal edema may result in temporary hyperopia. In addition, IOL power calculation may be problematic and may result in ametropia. Calculation of implant power for cataract surgery after RK should be done by first using a third-generation formula (eg, Haigis, Hoffer Q, Holladay 2, or SRK/T) rather than a regression formula (eg, SRK I or SRK II) and then choosing the highest resulting IOL power. Keratometric power is determined in 1 of 3 ways: direct measurement using corneal topography; application of pre-RK keratometry value minus the refractive change; or adjustment of the base curve of a plano contact lens by the overrefraction (see the section Eyes With No Preoperative Information in Chapter 11).

    A useful online resource for calculating IOL power in a post-RK patient is the post–refractive surgery IOL power calculator available on the website of the American Society of Cataract and Refractive Surgery (ASCRS), www.ascrs.org, and directly at http://iolcalc.ascrs.org (see Chapter 11). In addition, modalities such as intraoperative wavefront aberrometry can be used to obtain real-time IOL calculations that may help improve refractive outcomes.

    Incision placement and construction is vital when performing cataract surgery in the post-RK patient. Scleral tunnel incisions are often preferred, because clear corneal incisions increase the risk of the blade transecting the RK incision, which can induce irregular astigmatism. To help reduce preoperative corneal astigmatism, the surgeon may consider placing the incision in the steep astigmatic meridian of the cornea; in addition, toric IOLs can be used in patients with regular astigmatism but multifocal IOLs should be avoided. At the conclusion of surgery, care should be taken to prevent overhydrating the cataract incisions to avoid rupture of the RK incisions.

    • Anbar R, Malta JB, Barbosa JB, Leoratti MC, Beer S, Campos M. Photorefractive keratectomy with mitomycin-C for consecutive hyperopia after radial keratotomy. Cornea. 2009;28(4): 371–374.

    • Chen M. An evaluation of the accuracy of the ORange (Gen II) by comparing it to the IOLMaster in the prediction of postoperative refraction. Clin Ophthalmol. 2012;6:397–401.

    • Hemmati HD, Gologorsky D, Pineda R. Intraoperative wavefront aberrometry in cataract surgery. Semin Ophthalmol. 2012;27(5–6):100–106.

    • Hill WE, Byrne SF. Complex axial length measurements and unusual IOL power calculations. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2004, module 9.

    • Joyal H, Grégoire J, Faucher A. Photorefractive keratectomy to correct hyperopic shift after radial keratotomy. J Cataract Refract Surg. 2003;29(8):1502–1506.

    • Linebarger EJ, Hardten DR, Lindstrom RL. Laser-assisted in situ keratomileusis for correction of secondary hyperopia after radial keratotomy. Int Ophthalmol Clin. 2000;40(3):125–132.

    • Majmudar PA, Schallhorn SC, Cason JB, et al. Mitomycin-C in corneal surface excimer laser ablation techniques: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(6):1085–1095.

    • Nassaralla BA, McLeod SD, Nassaralla JJ Jr. Prophylactic mitomycin C to inhibit corneal haze after photorefractive keratectomy for residual myopia following radial keratotomy. J Refract Surg. 2007;23(3):226–232.

    • Salamon SA, Hjortdal JO, Ehlers N. Refractive results of radial keratotomy: a ten-year retrospective study. Acta Ophthalmol Scand. 2000;78(5):566–568.

    • Seitz B, Langenbucher A. Intraocular lens calculations status after corneal refractive surgery. Curr Opin Ophthalmol. 2000;11(1):35–46.

    • Shammas. HJ. Intraocular lens power calculation in patients with prior refractive surgery. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology; 2013, module 6.

    • Wang Ll, Hill WE, Koch DD. Evaluation of intraocular lens power prediction methods using the American Society of Cataract and Refractive Surgeons Post-Keratorefractive Intraocular Lens Power Calculator. J Cataract Refract Surg. 2010;36(9):1466–1473.

    Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.

  • Most Commented
    Loading, please wait...
    There are no comments available.
    Most Viewed
    Loading, please wait...
    Most Viewed content is not available.
  • The Academy Store
    2022-2023 Basic and Clinical Science Course, Complete Print Set
    2022-2023 Basic and Clinical Science Course, Complete eBook Set
    2022-2023 Basic and Clinical Science Course, Complete Print and eBook Set
    2022-2023 Basic and Clinical Science Course, Residency Print Set
    2022-2023 Basic and Clinical Science Course, Residency eBook Set
    2022-2023 Basic and Clinical Science Course Complete Set
    2022-2023 Basic and Clinical Science Course Residency Set
    2022-2023 Basic and Clinical Science Course, Section 01: Update on General Medicine
    2022-2023 Basic and Clinical Science Course, Section 02: Fundamentals and Principles of Ophthalmology
    2022-2023 Basic and Clinical Science Course, Section 03: Clinical Optics and Vision Rehabilitation
    2022-2023 Basic and Clinical Science Course, Section 04: Ophthalmic Pathology and Intraocular Tumors
    2022-2023 Basic and Clinical Science Course, Section 05: Neuro-Ophthalmology
    2022-2023 Basic and Clinical Science Course, Section 06: Pediatric Ophthalmology and Strabismus
    2022-2023 Basic and Clinical Science Course, Section 07: Oculofacial Plastic and Orbital Surgery
    2022-2023 Basic and Clinical Science Course, Section 08: External Disease and Cornea
    2022-2023 Basic and Clinical Science Course, Section 09: Uveitis and Ocular Inflammation
    2022-2023 Basic and Clinical Science Course, Section 10: Glaucoma
    2022-2023 Basic and Clinical Science Course, Section 11: Lens and Cataract
    2022-2023 Basic and Clinical Science Course, Section 12: Retina and Vitreous
    2022-2023 Basic and Clinical Science Course, Section 13: Refractive Surgery
    The Technician Point System: How to Improve Practice Accountability and Bottom Line (Free Member Webinar)
    Transitioning Your Practice: Retiring, Selling or Buying a Practice (Free Member Webinar)
    2022 IRIS Registry (Intelligent Research in Sight) Preparation Kit
    Advances in Medical and Surgical Management: The 2022 Update on Glaucoma
    Presbyopia-Correcting IOLs
    2022 Codequest - Multistate (Recorded March 29)
    2022 Codequest Virtual (Multistate)
    Retina Patient Education Video Collection
    Cataract and Refractive Surgery Patient Education Video Collection
    Glaucoma Patient Education Video Collection
 
  • Contact Us
  • About the Academy
  • Jobs at the Academy
  • Financial Relationships with Industry
  • Medical Disclaimer
  • Privacy Policy
  • Terms of Service
  • Help
  • For Advertisers
  • For Media
  • Ophthalmology Job Center

OUR SITES

  • EyeWiki
  • International Society of Refractive Surgery

FOLLOW THE ACADEMY

Medical Professionals

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube

Public & Patients

  • Facebook
  • Twitter
  • Instagram
  • YouTube

Museum of the Eye

  • Facebook
  • Twitter
  • Instagram
  • YouTube
  • Trip Advisor
  • Yelp
© American Academy of Ophthalmology 2022