Foreign body entrapment in radial keratotomy incisions.

Report of a Case. A 41-year-old man had successful bilateral 8-incision RKs done elsewhere in 1992, resulting in 20/20 OU uncorrected visual acuity. As he was trimming a bush in September 1998, a branch (Figure 1) struck him in the right eye. There was immediate pain, blurriness, and tearing. He was seen immediately at a local hospital emergency department by an ophthalmologist and was referred to our cornea clinic for further treatment. At presentation to our clinic, his uncorrected visual acuity was 20/70 OD and 20/20 OS. Manifest refraction in the right eye improved the visual acuity to 20/50 with a +0.75+1.003135 correction. Dark brown particles of what appeared to be wood bark were wedged in the anterior corneal stroma in the nasal, inferonasal, and inferior RK incisions (Figure 2). The anterior lips of these incisions were splayed open by a combination of the foreign bodies, reactive inflammation, and secondary corneal edema. In addition, there was a partialthickness, paracentral corneal laceration perpendicular to and crossing the 3 injured RK incisions. Findings from the Seidel test were negative. The rest of the anterior segment, including the crystalline lens, was normal. A dilated retinal examination revealed no intraocular foreign bodies or retinal pathologic condition. Under retrobulbar anesthesia, the foreign bodies were easily swept out of the RK incisions with a Barraquer iris sweep and were sent for microbiological cultures. The 3 RK incisions, together with the anterior stromal laceration, were copiously irrigated with balanced-salt solution. A subconjunctival injection of cephalosporin was administered and a 1-week course of topical ofloxacin, 4 times daily, was begun. The uncorrected visual acuity improved to 20/30 OD within 1 week. After 5 weeks, the RK incisions and the paracentral laceration appeared to be healing well, with only mild anterior stromal scarring and mild residual fluorescein pooling over the injured incisions. The uncorrected visual acuity remained 20/30 OD. The cycloplegic refraction was -0.25+0.25330 OD, giving a corrected visual acuity of 20/25 OD. The cultures were negative for organisms.