Refractive Outcomes and Early Corneal Changes after Cataract Surgery in Post-Radial Keratotomy Eyes

Purpose Cataract surgery in eyes with previous radial keratotomy (RK) remains challenging due to unstable corneal biomechanics and unreliable intraocular lens (IOL) power calculation. This study aimed to evaluate early postoperative corneal changes and to explore refractive outcomes obtained with the Barrett True-K formula using the RK and myopic LASIK modes in post-RK eyes. Methods This retrospective, exploratory case series included seven eyes with a history of RK that underwent uncomplicated phacoemulsification with monofocal IOL implantation. Postoperative evaluations were performed at approximately 1-2 weeks (FU#1) and 5-6 weeks (FU#2). Refractive prediction errors were calculated for both RK and myopic LASIK modes of the Barrett True-K formula. Given the small sample size and inclusion of bilateral eyes, the analyses were considered exploratory. Results Postoperative best-corrected visual acuity improved at FU#2. Early corneal flattening at FU#1 was followed by partial recovery at FU#2, while central corneal thickness showed transient postoperative thickening with subsequent normalization. At FU#2, the arithmetic prediction error was +0.13 ± 0.82 D in RK mode and -0.99 ± 0.63 D in myopic LASIK mode; the corresponding absolute prediction errors were 0.72 ± 0.28 D and 0.99 ± 0.63 D, respectively. Conclusions Early postoperative corneal instability persists after cataract surgery in post-RK eyes. In this small exploratory case series, the RK and myopic LASIK modes showed different early prediction-error profiles; however, the study does not establish the superiority of either mode, and longer follow-up in larger independent cohorts is required.