Small-aperture corneal inlay in patients with prior radial keratotomy surgeries
A 53-year-old female who had had an RK surgery 15 years prior complained about her near visual acuity. There was no other ocular history of note other than a laser-assisted in situ keratomileusis (LASIK) procedure 7 years ago for residual refractive error correction after her RK surgery. On examination, uncorrected and corrected visual acuity for near and for distance were checked. The pachymetry before inlay implantation was 498 μm.\nA corneal pocket was created with FEMTO LDV™ Crystal Line (Ziemer Ophthalmic Systems AG, Port, Switzerland). The pocket formation was done at 270° inferiorly, not temporally as is usually the case. The surgical technique was targeted to minimize the risk of any intersection with the prior RK incision to avoid the extension of the RK wound into the interface. Using a slit lamp, it was observed that the depth of the inferior incisions was at 40%–50% of the corneal thickness. The other incisions were to a depth of 90% of the corneal thickness. Considering this, the surgeon preferred to make the pocket at 270° inferiorly (depth 250 μm). The inlay was removed with forceps from the sterile package and inspected under high magnification for any defects, before being carefully placed in the pocket () over the estimated line of sight based on the midpoint of the first Purkinje image and the pupil center with coaxial patient fixation.