Scholarlink

Purpose <p>To report bilateral sequential phacoemulsification in a patient with high-myopia post-radial keratotomy (RK) corneas and bilateral chorioretinal atrophy, complicated by corneal wound dehiscence at an RK scar during intraocular lens (IOL) implantation in the second eye performed by a supervised resident, and to discuss the structural, refractive, and training-related implications of surgery in this challenging population.</p> Case summary <p>A 65-year-old man with bilateral 8-cut RK performed approximately 30 years prior for high myopia (− 16.00 D) presented with bilateral visually significant cataract. Axial length was 28–29&#xa0;mm in both eyes; post-RK Scheimpflug tomography (Sirius, CSO) showed marked central flattening with simulated keratometry of approximately K1 29 D / K2 35 D bilaterally (mean central corneal power ≈ 31–33 D); preoperative BCVA was 0.05 (20/400) bilaterally due to pre-existing chorioretinal atrophy and posterior staphyloma. Right eye surgery by the senior surgeon (F.S.) was uneventful; a + 16.0 D IOL was implanted and postoperative BCVA reached 0.4–0.5. Left eye surgery was performed by a supervised resident under direct attending supervision. Phacoemulsification of a grade 2–3 nucleus was uneventful; however, during IOL unfolding and implantation, mechanical stress was transmitted along the tract of an old RK incision, precipitating full-thickness corneal wound dehiscence. The attending surgeon intervened immediately, repairing the dehiscence with three interrupted 10 − 0 nylon sutures. Final BCVA in the left eye was 0.3–0.4, limited primarily by pre-existing chorioretinal atrophy rather than by the intraoperative complication.</p> Conclusion <p>Post-RK corneas harbour latent structural vulnerabilities that may be unmasked by the mechanical forces of IOL implantation rather than phacoemulsification itself. These cases should be considered high-complexity and assigned exclusively to experienced surgeons. The bilateral design of this case provides a unique intraoperative comparison and highlights the necessity of pre-consent for suturing, realistic visual prognosis counselling, and strict case selection criteria in supervised surgical training programmes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Corneal wound dehiscence at a radial keratotomy scar during iol implantation: a bilateral teaching case

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月24日

查看全文
  • Fatma Sumer,
  • Ahmet Melih Oncirak,
  • Bunyamin Can

摘要

Purpose

To report bilateral sequential phacoemulsification in a patient with high-myopia post-radial keratotomy (RK) corneas and bilateral chorioretinal atrophy, complicated by corneal wound dehiscence at an RK scar during intraocular lens (IOL) implantation in the second eye performed by a supervised resident, and to discuss the structural, refractive, and training-related implications of surgery in this challenging population.

Case summary

A 65-year-old man with bilateral 8-cut RK performed approximately 30 years prior for high myopia (− 16.00 D) presented with bilateral visually significant cataract. Axial length was 28–29 mm in both eyes; post-RK Scheimpflug tomography (Sirius, CSO) showed marked central flattening with simulated keratometry of approximately K1 29 D / K2 35 D bilaterally (mean central corneal power ≈ 31–33 D); preoperative BCVA was 0.05 (20/400) bilaterally due to pre-existing chorioretinal atrophy and posterior staphyloma. Right eye surgery by the senior surgeon (F.S.) was uneventful; a + 16.0 D IOL was implanted and postoperative BCVA reached 0.4–0.5. Left eye surgery was performed by a supervised resident under direct attending supervision. Phacoemulsification of a grade 2–3 nucleus was uneventful; however, during IOL unfolding and implantation, mechanical stress was transmitted along the tract of an old RK incision, precipitating full-thickness corneal wound dehiscence. The attending surgeon intervened immediately, repairing the dehiscence with three interrupted 10 − 0 nylon sutures. Final BCVA in the left eye was 0.3–0.4, limited primarily by pre-existing chorioretinal atrophy rather than by the intraoperative complication.

Conclusion

Post-RK corneas harbour latent structural vulnerabilities that may be unmasked by the mechanical forces of IOL implantation rather than phacoemulsification itself. These cases should be considered high-complexity and assigned exclusively to experienced surgeons. The bilateral design of this case provides a unique intraoperative comparison and highlights the necessity of pre-consent for suturing, realistic visual prognosis counselling, and strict case selection criteria in supervised surgical training programmes.