Guifré Álvarez, Amanda Rey, Pablo Díaz ICOF. Hospital Clinic i Provincial. Barcelona (Spain) FINANCIAL DISCLOSURE: The authors have no financial interest in the subject matter of this e-poster RUPTURE OF RADIAL KERATOTOMY WOUND WITH APHAKIA AND ANIRIDIA BY BLUNT TRAUMA

PURPOSE: To report a case of traumatic corneal rupture with extrusion of iris and lens, that occurred eight years after radial keratotomy, and its management. INTRODUCTION: Radial keratotomy (RK) was the most widely carried out refractive surgical technique for the correction of myopia. Eventually, however, this practice has been abandoned with the development of laser eye surgery methods. In RK, severe complications such as photophobia, recurrent erosions, keratitis, cataract, micro or macoperforations, visual distortion of light, over or undercorrection, endophtalmiti. In addition, wound dehiscence have been reported, even several years after the surgery.

METHODS: A 27 year-old man presented a corneal rupture in his left eye after blunt trauma 8 years ago a radial keratotomy (RK) was performed Slit lamp examination of his left eye showed dehiscence of the radial incision at three o’clock position, extrusion of the iris and the lens, and a vitreous haemorrhage Ecography: absence of iris and lens, no retinal detachment At the emergency theatre the corneal laceration was sutured with nylon 10-0 and a vitrectomy was performed

- Two months after the surgery best corrected visual acuity was 20/30 with a rigid contact lens of +11 dioptres (D) - Because of intolerance to contact lens and extreme photophobia, at the eight month a 24D blue aniridia lens (Ophtec HMK ANI blue) was implanted using our habitual technique of sulcus fixation at the 2 and 8 o’clock position with scleral patch for suture exposure (see video).

RESULTS: After this second surgery and suture removal at the third month of the postoperative course, best spectacle visual acuity improved to 20/25 (110º ) and the patient had no more complaints about photophobia. Figures A and B corresponding at the first day and second month, respectively, of the postoperative A BA

CONCLUSIONS: RK structurally compromises the eye: scars never regain the original tensile strenght of the unoperated cornea. Histopathologic and ultrastructural studies have demonstrated that the corneal keratotomy scars show incomplete healing. Even after several years after surgery, blunt traumas represent a definite risk for eyes undergoing radial keratotomy and patients should be counselled about it. Despite the severity of the traumatic incision rupture, some cases with a properly management can achieve good visual results. REFERENCES: Rashid ER, Waring G. “Complications of radial and transverse keratotomy”. Surv Ophthalmol 1998; 34: Khoroshilova-Maslova IP et al. “Clinical and histopathological examination of enucleated eyes with contusion ruptures of cornea after radial keratotomy”. Vestn Oftalmol 1998; 114 (4): 3-8 Sony P. “Traumatic corneal rupture 18 years after radial keratotomy”. J Refr Surg 2004; 20(3): 283-4