Management of radial keratotomy overcorrections by corneal sutures

Refractive hyperopia is a significant complication after radial keratotomy (RK). In this study, we corrected it by suturing the radial incisions, using purse-string sutures, and using a combined technique. Thirteen patients (six original overcorrections, four overcorrections after reoperation, and three progressive hyperopes) were included, demonstrating that the techniques induced a wide range of central corneal steepness and therefore corrected variable amounts of hyperopia. However, only the combination of purse-string suture and radial incision suturing provided a stable result. One patient in the purse-string group and two in the radial group required a third combined surgery to achieve an acceptable result. In the combined group, all cases achieved an improvement in visual acuity. While all cases were within 1 diopter of emmetropia, in seven cases pre-RK visual acuity was equal to the best corrected visual acuity six months after surgery. Preoperative best corrected visual acuity was maintained in all cases. Suture removal at the sixth month postoperatively did not seem to influence the refractive result. Our results suggest that neither purse string nor radial suturing is enough to achieve the girdle effect to the cornea; they must be combined. A significant regression of the effect should be expected following the suture placement, mainly during the early postoperative period, until a stable result is achieved about six months later. A computer-assisted photokeratoscope image was taken preoperatively and postoperatively, showing that some irregular astigmatism should be expected as a result of the procedure.