Cataract Surgery After Refractive Surgery

Ravi H. Patel, MD; Carol L. Karp, MD; Sonia H. Yoo, MD; Guillermo Amescua, MD; Anat Galor, MD, MSPH


Int Ophthalmol Clin. 2016;56(2):171-182. 

In This Article

Operative Considerations

Radial Keratotomy

Patients with previous radial keratotomy (RK) surgery have some intraoperative considerations to minimize postoperative complications. First, all incisions should be made in between the RK incisions to avoid wound dehiscence or leaks and to prevent irregular astigmatism post-operatively. However, some patients may have >8 RK incisions and in this scenario, a scleral tunnel approach may be beneficial. Finally, RK incisions are weak points in the cornea and can be opened during surgery using standard phacoemulsification settings. Surgeons should be prepared to suture incisions and should consider lowering phacoemulsification parameters to minimize operative complications. Patients should be counseled at length regarding the risk of irregular astigmatism, and hyperopic drift depending on corneal stability.


In patients with a history of LASIK, the flap and hinge position should be determined and accounted for when planning surgical incisions. It remains important to not disrupt the flap during surgery as to keep the risk of epithelial ingrowth at a minimum. In the case of photo refractive keratectomy (PRK), it is important to note the degree of haze, if any, preoperatively. Given a potential for limited view during cataract surgery, Trypan blue could be used to aid in visualization of the anterior capsule to make a capsulorrhexis.