Additional refractive surgery after LASIK is more challenging than other circumstances, but is still extremely effective. Because RK was done routinely from the early 1980s to the mid-1990s and weakens the cornea, many of these patients come in with farsighted prescriptions and early cataracts because they are age fifty and older, making lensectomy/IOL my procedure of choice for the majority of them. In many of these circumstances, insurance will get
involved in paying for the procedure.
Accuracy is one of the issues with performing lens surgery in RK patients.
There are three issues with performing lens surgery in RK patients. The first is the accuracy of the procedure. Because of the previous corneal surgery, the lens calculation used to pick the correct IOL power is much more difficult than if the patient had not had surgery. We employ special tests to help improve the accuracy of the calculation, but there is still a high risk of needing additional treatment with surface PRK. In fact, I tell RK patients undergoing lensectomy/IOL to expect a two-stage operation, with the PRK occurring three months after the lens procedure.
Second, it takes longer to heal.
The second issue is that RK patients take longer to heal after lensectomy/IOL surgery because of swelling of the RK incisions that creates flattening of the cornea and induced astigmatism and/or farsightedness, requiring a few months to stabilize.
Lastly, complications can come along with past incisions opening up.
The last issue with lens surgery in RK patients is the fact that sometimes the previous incisions will open at the time of lens surgery, requiring sutures to close them that can induce astigmatism. While I place the opening into the eye for cataract surgery as far away from the RK incisions as possible, this still sometimes occurs. Fortunately, the sutures are removed in the first few months and any residual astigmatism is very treatable with additional PRK.
PRK is generally the primary treatment that we use with younger RK patients.
In younger RK patients who do not have a high farsighted prescription or early cataracts, I use PRK as my primary treatment. LASIK has been used in the past, but there is a very high risk of the previous incisions opening which can allow cells to grow from the surface under the flap (epithelial ingrowth). Significant epithelial ingrowth can create flap melts, induced astigmatism, and blurry vision, requiring additional surgery. Performing PRK on previous RK patients avoids this issue. While PRK on an RK eye is slightly less accurate than on a virgin cornea, resulting in a higher enhancement rate for these eyes, PRK is safe and highly effective.
Dr. Paul J. Dougherty
Medical Director – Dougherty Laser Vision