Long Term Follow-up of the Corneal State after Anterior Radial Keratotomy

Abstract

Purpose: to investigate the cornea condition in the patients after anterior radial keratotomy in long-term (over 20 years) period. Patients and methods. The study involved 80 patients (147 eyes) aged from 41 to 65 years, who had keratotomy in average 23.9 ± 1.9 years ago. The number of keratotomy scars varied from 6 to 18. Radial keratotomy was performed in 125 eyes, in 22 eyes — radial and tangential keratotomy, repeat radial keratotomy about residual moderate myopia was performed in 3 eyes. Ophthalmologic examination of patients included conventional techniques. Results. In 76.2% of cases in the corneal optical zone were observed accumulation of hemosiderin; in 63.3% — signs of intraoperative micro- and macroperforations, going through all cornea layers, capturing the Descemet membrane and the endothelium, leading to a decrease in the density of endothelial cells. There was subepithelial fibrosis in 2.7% cases; the signs of postkeratotomic keratectasia with expressed refractive disorders and prevalence of hyperopic complex or mixed forms of astigmatism were in 9.5%; during the endothelial microscopy in 21.8% of cases «dark zones» were revealed. It in combination with pleomorphism and polimegatizm indicates a decrease of endothelial functional reserve in patients after anterior radial keratotomy. Conclusions. The special features of the cornea state oafter keratotomy in the long term are including the accumulation of hemosiderin in the corneal optical zone, the signs of intraoperative perforation in the area of keratotomy scars, subepithelial fibrosis, postkeratotomy keratectasia, reducing of the density of endothelial cells, pleomorphism, polimegatizm, «dark zones» found at endothelial microscopy