Radial keratotomy learning curve using the American technique

Purpose: To delineate the learning curve for a beginning refractive surgeon using the centrifugal (American) technique. Setting: Naval Medical Center, San Diego, California, USA. Methods: The first 100 radial keratotomy (RK) cases (51 patients) of one surgeon, divided into five sequential groups of 20, were retrospectively reviewed. All patients had RK using the American technique. Emmetropia was the goal in ail patients. Groups were compared with respect to preoperative refractive status, age, sex. and outcome, Outcomes analysis included visual acuity, refractive error, complications, and enhancement rates. Data were reviewed preoperatively and 1 and 3 months postoperatively. Results: Ail five groups were age and sex matched. There was no difference in preoperative refractive error among the five groups. Sequential improvement in early postoperative refractive error from a mean of -1.73 diopters (D) +/-1.00 (SD) (first 20) to 0.45 +/- 0.55 D (last 20) (P < .001) and decreased enhancement rates from 50% (first 20) to 0% (last 20) (P = .002) were statistically significant. Visual acuity at 1 month was 20/40 or better in 47% of patients in Group 1 (first 20), whereas all patients in Group 5 (last 20) had an acuity better than 20/40 (P < .001). There was no significant difference in complication rates among the five groups. surgeon. Conclusion: The results of RK using the American technique can improve significantly with surgeon experience. Enhancement rates decreased with experience, and there was no difference in complication rates during the learning period of one surgeon.