Corneal topography and postoperative refraction after cataract phacoemulsification following radial keratotomy

We present one case in which phacoemulsification was performed seven years after radial keratotomy (RK). A 55-year-old military police officer had undergone successful bilateral RK for the correction of myopia seven years before he developed a cataract in his left eye. Pre-RK keratometric and refractive data and post-RK myopia reduction were not available. We relied upon corneal topography to measure corneal refractive power. We took the Effective Refractive Power (EffRP) index from EyeSys Holladay's Diagnostic Summary and used SRK-T formula for IOL calculation. A-scan axial length readings were consistent and reliable (AL = 26.0 mm). Aiming at postoperative emmetropia, we implanted a +20D PC IOL (A cost. = 118) was implanted. The lens was expected (SRK-T formula) to give a -1.35D postoperative refraction. After uneventful cataract surgery, corneal topography showed significant corneal instability with central corneal flattening in the first postoperative weeks, mild central corneal steepening at week 6, and return to preoperative corneal curvature at week 23. One year after cataract extraction, the patient's spherical equivalent is +1.12D, showing a prediction error of about 2.5 diopters.