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Phaco incision size in post-RK eyes
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Prior RK makes cataract surgery more challenging for the surgeon, both mentally and technically. But since these post-RK patients often have high degrees of hyperopia and are symptomatic from cataracts earlier than the average patient, cataract surgery can give a large improvement in vision.
 Using a diamond knife to make a phaco incision between RK incisions. |
The mental challenge is determining the ideal IOL power because lens calculations are far less accurate in post-RK eyes. This is due to the difficulties in determining the true corneal power and the effective lens position. The technical challenge is making the phaco incision without intersecting the pre-existing RK incisions.
Intersecting the RK incisions with the phaco incision can cause problems. The RK incisions can rip open, and excessive leakage of infusion fluid from the eye will lead to chamber instability, surge and a high risk for posterior capsule rupture. With the advent of micro-phaco technologies, we can further decrease the incision size from the traditional 2.8 mm to 3 mm, to 1.8 mm to 2.2 mm. This allows the phaco incision to be placed between the RK incisions. And one-piece acrylic IOLs can now be implanted through these same un-enlarged incisions.