A 28-year-old female had radial keratotomy on April 24, 1989 for a refractive error of - 3.75 - 3.50 × 180°.
Central ultrasonic pachometry measurement was 0.52 mm and the knife blade was set for eight radial incisions at 0.49 mm, using an optical zone of 3.0 mm. Two microperforations occurred paracentrally at the 7:30 and 9:00 incisions without visible flattening of the anterior chamber. The operation was completed with four transverse incisions in the 90° meridian at zones of 5.00 mm (blade length 0.54 mm) and at 7 mm (blade length 0.57 mm). At the conclusion of surgery, the wounds were irrigated with Hartmann solution and topical cyclopentolate and gentamicin were applied along with a pressure patch and shield.
On the first postoperative day, the cornea was clear except for slight edema around the incisions and the anterior chamber was of normal depth. The central two thirds of the 7:30 incision demonstrated a herneation of Descemets membrane (Figure 1) in the form of a Descemetocele. Cyclopentolate was administered and a pressure patch applied. One day later, the Descemetocele had disappeared and the wound showed good coaptation of the margins with no leakage of aqueous humor. Single interrupted nylon sutures were placed paracentrally in the 7:30 and 9:00 meridian (Figure 2).
The remainder of the postoperative course was uneventful.
The 7:30 incision extended full thickness through the cornea and created a small puncture wound in Descemet's membrane that apparently closed spontaneously, allowing the intraocular pressure to force Descemet's membrane into the wound so that it protruded anteriorally as a Descemetocele. This resolved spontaneously, either because the small perforation in Descemet's membrane opened again relieving the prolapse or possibly because of natural fluctuations of intraocular pressure.
Figure 1. Herniation ot Descemet's membrane at central two thirds of 7:30 incision.
Figure 2: Single interrupted nylon suture at paracentral of 7:30 and 9:00 meridian.
This complication of radial keratotomy has not been previously published.