Patient's cornea looked like spoke of bicycle- a case report

Dr Muralidhar Ramappa at LV Prasad Eye Institute, Hyderabad, India and colleagues have reported a case in which patient's cornea looked like spoke of a bicycle on examination, suggestive of Radial Keratotomy done for treating myopia. The case has appeared in NEJM.

Radial keratotomy was a popular procedure in the 1980s and 1990s for treating myopia, before the development of laser eye surgery. Because radial keratotomies are performed manually, the incisions are neither perfectly radial nor symmetric. However, the procedure is associated with a number of complications. Overlapping or excessively central incisions may lead to reduced visual acuity, and corneal scarring is associated with glare and halos. Patients are at risk for progressive hyperopia and, in rare cases, owing to reduced corneal biomechanical strength, globe rupture with minimal trauma.

According to history, a 41-year-old woman presented to the ophthalmology clinic with a vision that had been deteriorating during the preceding 20 years. Her subjective refraction showed that a hyperopic shift had occurred since her current corrective lenses had been prescribed. Her best corrected visual acuity was 20/25 in both eyes. Slit-lamp examination revealed faint cuts in the woman's eyeball look like spokes on a bicycle wheel, or a poorly-sliced pizza — numerous thin lines arranged to form a radial pattern.

These features suggested that radial keratotomy had been performed: a clear central cornea with 16 corneal incisions extending from the periphery.

Courtesy NEJM

The patient confirmed that she had undergone this surgery for the treatment of myopia 23 years before presentation. At the time of the procedure, she had had no immediate complications. The patient received a new prescription for corrective lenses and was advised of the importance of protective eyewear. At a 6-month follow-up visit, her vision had not deteriorated further.

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DOI: 10.1056/NEJMicm1808841