Complications of radial and transverse keratotomy

Radial keratotomy for myopia and transverse keratotomy for astigmatism are the most commonly performed refractive surgical procedures. A decade of experience with modern techniques has produced considerable literature on the complications of keratotomy. Vision-threatening complications (bacterial keratitis, traumatic rupture of the globe through weakened keratotomy scars, endophthalmitis, cataract formation from surgical trauma to the lens) are quite rare, occurring in less than 1% of eyes in published series. The most common side effects affect most patients in the first few months after surgery: pain for 24 to 48 hours, transient glare and light sensitivity, and fluctuating visual acuity. The most common persistent complications are overcorrection and undercorrection. Persistent irregular astigmatism occurs in almost all cases in the region of the incision scars, but it is rarely severe enough to reduce spectacle acuity. Most individuals have mild glare, but this is rarely disabling. Diurnal variation of refraction in visual acuity occurs commonly, but the magnitude of the fluctuation is seldom enough to require multiple pairs of spectacles. Longterm refractive stability occurs in approximately half of eyes by six months, but approximately one in four eyes will experience continued change over six months to four years. Complications, such as scarring from intersecting keratotomy incisions, irregular astigmatism resulting from multiple reoperations, and overcorrections with the attendant early onset of symptomatic presbyopia are becoming much less frequent.