Two-incision radial keratotomy for low myopia with astigmatism

Purpose: To evaluate the effectiveness of two-incision radial keratotomy (RK) in correcting low-magnitude refractive myopic astigmatism. Setting: Two clinical study sites, one in St. Louis, Missouri, USA, the other in Caracas, Venezuela. Methods: Fifty-seven eyes of 43 patients with low-magnitude myopic astigmatism had two-incision RK at one of two clinical study sites. In the initial phase of this series, 10 eyes with amblyopia at the 20/30 level had surgery at one center. Refractive keratotomy was performed with the radial incision placed in the plus cylinder axis of refraction. This axis was verified as the meridian of greatest corneal curvature by standard keratometry and computer-assisted corneal topographic analysis. Two eyes received a second operation (enhancement). Results: Mean follow-up was 11.1 months (range 6 to 12 months). Mean preoperative and postoperative myopic spherical equivalent measured -1.42 diopters (D) ± 0.51 (SD) and -0.14 ± 0.39 D, respectively; the mean reduction was 1.28 ± 0.59 D (P = .0001). Mean preoperative and postoperative refractive astigmatism was 1.41 ± 0.45 D and 0.48 ± 0.33 D, respectively (P = .0001). Mean preoperative and postoperative keratometric astigmatism was 1.26 ± 0.54 D and 0.31 ± 0.35 D, respectively, a mean reduction of 0.95 D (P = .0001). The surgical meridian was flattened by an average of 2.06 D by keratometry and the orthogonal meridian, by an average of 1.10 D. Preoperative uncorrected visual acuity (UCVA) was 20/40 or better in five (9%) eyes (range counting fingers to 20/40). Postoperative UCVA acuity was 20/40 or better in all eyes (mean acuity 20/25). In the nonamblyopic subgroup, mean postoperative UCVA was 20/24. Conclusions: A limited number of radial incisions placed in the topographically confirmed axis of greatest curvature are effective in the treatment of low-magnitude myopic astigmatism.