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Concept
Radial keratotomy
Résumé
Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness). It was developed in 1974 by Svyatoslav Fyodorov, a Russian ophthalmologist. It has been largely supplanted by newer, more accurate operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens.
When performing RK, incisions are made with a diamond knife. The incisions relax the steep central cornea in patients with myopia in order to achieve a decreased need for correction. The original technique – consisting of incisions from periphery to center – was called the "Russian technique", while the later advances of performing controlled incision from center to periphery was called the "American technique".
RK may be performed with different types, numbers, and patterns of incisions. Typically, between 4 and 24 radial incisions are made in a number of patterns and orientations based on refractive errors, surgeon style and surgeon training. RK with 8 incisions is most common.
Incisions that penetrate only the superficial corneal stroma are less effective than those reaching deep into the cornea, and consequently, incisions are made quite deep. One study cites incisions made to a depth equivalent to the thinnest of four corneal-thickness measurements made near the center of the cornea. Other sources cite surgeries leaving 20 to 50 micrometres of corneal tissue unincised (roughly equivalent to 90% of corneal depth, based on thickness norms).
The procedure results in a decrease in nearsightedness. According to the PERK study, 58% of eyes were corrected within 1.00D of goal 3 years after surgery. Additionally, 76% of eyes had uncorrected vision of 20/40 or better at 3 years. From 2 to 10 years post-operatively 43% of eyes had an increase in farsightedness by 1.00D or more. Despite this, 70% of patients reported not requiring corrective lenses for distance vision 10 years after surgery.
The healing corneal wounds consist of newly abutting corneal stroma, fibroblastic cells, and irregular fibrous connective tissue.
Source officielle
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