Histopathology of a case of radial keratotomy

A patient underwent a radial keratotomy (RK) to reduce residual astigmatism that occurred after a corneal transplant. The patient enjoyed immediate good vision, but later intense glare, photophobia, and pain forced him to quit work. Five months later the graft became cloudy, and superficial vascularization developed in the radial scars. An 8.5-mm penetrating keratoplasty was performed 5 1/2 months after RK. Analysis of the corneal button revealed diffuse epithelial edema, epithelial ingrowth into the incisions, an irregularly thickened epithelial basement membrane, immature hemidesmosomes, focal malapposition of Bowman's layer, marked cellularity of the stroma around the margins of the incisions, and posterior folds in Descemet's membrane. Our analysis of this specimen suggests RK may carry a risk of optical and visual aberrations by producing multiple defects in the anterior and posterior aspects of the cornea.