Radial keratotomy in intact epikeratoplasty graft

Epikeratoplasty can be used to flatten the cornea in keratoconus but is not a satisfactory tool to correct refractive errors in this setting. Radial and astigmatic keratotomy are unpredictable in keratoconus but can be used in an eye which has previously undergone epikeratoplasty for keratoconus.

We report a case of a pseudophakic eye with Keratoconus which received epikeratoplasty and subsequently underwent radial and astigmatic keratotomy in the graft.

Before the refractive keratotomy, the patient had a refraction of -8.00 + 3.25 x 25. At 5 months after radial and astigmatic keratotomy, the patient had an uncorrected visual acuity of 20/60+ with a refraction of -0.50 + 2.00 x 28.

This case demonstrates how different types of refractive corneal surgery can be combined to improve visual acuity in an individual patient. Whether the specific combination of epikeratoplasty and refractive keratotomy can be advocated in the treatment of keratoconus requires more experience with a greater number of patients.