Radial keratotomy in a patient with keratoconus

A 33-year-old patient had radial keratotomy performed on both eyes for relief of longstanding myopia. Minimal reduction of myopia was obtained, and the patient underwent a second radial keratotomy in both eyes. Best corrected visual acuity decreased, and the patient had a marked, irregular astigmatism postoperatively. Careful ophthalmologic evaluation revealed that the patient had keratoconus bilaterally. Following a failed trial of contact lens wear, the patient underwent a penetrating keratoplasty of the right eye. Pathologic evaluation revealed findings of keratoconus, as well as radial keratotomy scars. This case report illustrates the importance of a complete ophthalmologic examination possibly including videokeratography, prior to keratorefractive surgery.