Asymmetric Presentation of Corneal Ectasia With Acute Hydrops 34 Years Following Bilateral Radial Keratotomy.

Despite the subsequent emergence of more advanced refractive surgical techniques, ophthalmologists continue to encounter patients who have experienced long-term complications from radial keratotomy (RK). A notable complication of RK is corneal ectasia, which, although rare, can lead to significant vision impairment years after the procedure. The present case report details a 54-year-old male patient who developed unilateral corneal ectasia with acute hydrops 34 years following bilateral RK. The patient exhibited symptoms including decreased vision, corneal opacity, thinning, and steepening in the right eye, while the left eye demonstrated only mild corneal changes. Notably, the development of acute hydrops with Descemet's membrane rupture was observed, mimicking the pathophysiology characteristic of keratoconus. A comprehensive discussion of the patient's clinical course, imaging findings, and management is presented, along with a review of the current treatment options for post-RK ectasia. This case underscores the necessity of prolonged follow-up for patients who have undergone RK, emphasizing the importance of vigilance for this uncommon complication, which can manifest decades after the initial procedure.