Visual Outcomes After Phacoemulsification Following Sequential Custom Therapeutic Keratectomy for Radial Keratotomy

Purpose: To evaluate the visual and refractive outcomes of sequential customized therapeutic keratectomy (SCTK) followed by phacoemulsification in patients with prior radial keratotomy (RK). Methods: This was a retrospective study of 29 eyes (19 patients) that underwent SCTK for corneal irregularity after RK, followed by phacoemulsification and intraocular lens (IOL) implantation at a tertiary eye center. Inclusion criteria were prior RK, SCTK performed to address visually significant higher order aberrations (HOAs), and a minimum follow-up of 3 months after cataract surgery. SCTK was performed using a stepwise protocol, guided by wavefront and topographic analysis. IOL power calculation was performed using the Camellin-Calossi formula with individually tailored target refractions (range: −0.50 to −3.00 diopters [D]; mean: −1.90 ± 0.92 D) documented in preoperative consent forms. Main outcomes included corrected distance visual acuity, spherical equivalent, HOA metrics, and refractive prediction error against the patient-specific target. Results: CDVA improved significantly from 0.49 ± 0.15 logarithm of the minimum angle of resolution (logMAR) before SCTK to 0.40 ± 0.21 logMAR after SCTK ( P = .02), and further to 0.25 ± 0.15 logMAR after phacoemulsification ( P < .01), remaining stable long-term (0.26 ± 0.20 logMAR, P = .72). Spherical equivalent shifted from −2.50 ± 4.30 D before SCTK to −10.20 ± 6.10 D after SCTK ( P < .01) and was corrected to −2.10 ± 1.20 D after phacoemulsification ( P < .01). Among patients, 52% gained three or more lines of CDVA, whereas no patient experienced a loss of CDVA. Conclusions: SCTK prior to cataract surgery in eyes with previous RK effectively reduces HOAs and facilitates accurate IOL calculation, leading to improved visual outcomes and long-term refractive stability. Using patient-specific target refractions, the Camellin-Calossi formula achieved a mean prediction error of −0.25 ± 0.63 D (mean absolute error: 0.45 D; median absolute error: 0.25 D), with 75.9% of eyes within ±0.50 D and 89.7% within ±1.00 D of their individual target.