Hyperopic refractive surgery

Abstract

Although the first attempts at hyperopia correction were made more than 100 years ago, it is only in the past several years that the success of hyperopic refractive surgery has begun to approach the efficacy of myopia surgery. Corneal surgery for the correction of hyperopia includes older lamellar techniques such as automated lamellar keratoplasty and epikeratophakia, and more recently photorefractive keratectomy and laser in situ keratomileusis. The latter two procedures have shown the most success. Using large diameter laser ablations and improved keratomes, laser in situ keratomileusis has become a realistic alternative for corrections of up to 4 or 5 diopters with astigmatic corrections. Laser thermal keratoplasty using the Holmium or diode laser and contact techniques also have gained popularity and shown some potential. Collagen shrinkage procedures are easy to perform and have relatively few complications, but over correction and regression are problems. Crystalline lens surgery and phakic intraocular lenses are being investigated actively and are promising; however, safety issues persist. The surgical treatments of hyperopia present a significant challenge and reward for the ophthalmic surgeon.

Toric phakic intraocular lens for the correction of hyperopia and astigmatism

“…Large treatment zones are necessary to correct astigmatism and hyperopia with LASIK or PRK. Hyperopic PRK appears to be relatively safe and effective for corrections up to C4.00 D. 3,19 In higher corrections, reduced predictability and possible loss of BSCVA are reported. 20 After treatment of hyperopic astigmatism with PRK, a higher percentage of eyes (15.8%) is reported to lose 2 or more lines of BSCVA.…”

“…1,2 Reported complications are regression, corneal ectasia, epithelial ingrowth, irregular astigmatism, and low predictability, especially in eyes with higher hyperopia or hyperopia combined with astigmatism. [3][4][5][6] Clear lens extraction with implantation of a toric intraocular lens (IOL) has the disadvantage of accommodation loss in a younger age group. Phakic IOLs can be an alternative for the correction of hyperopia and hyperopic astigmatism.…”

Long-term follow-up of hyperopic laser in situ keratomileusis correction using the Star S2 excimer laser

“…1,2 However, refractive surgeons have been cautious about performing LASIK to treat hyperopia because of challenges arising from the need to use larger ablation diameters to steepen the central cornea and the paucity of lasers that deliver a homogeneous distribution of energy in diameters that are often greater than 6.0 mm. 3 In many cases, the increased ablation area requires cutting a larger corneal flap than in myopic surgery, which can be difficult because many hyperopic eyes are smaller than myopic eyes. Being anatomically more conducive to smaller flaps, hyperopic eyes allow little room to apply the laser ablation to the exposed stromal bed.…”

Laser-assisted subepithelial keratectomy for bilateral hyperopia and hyperopic anisometropic amblyopia in children

“…Based on the results in this study and our experience with PRK and LASEK [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]41 in patients with anisometropic amblyopia, we believe that the elimination of anisometropia provides major visual and functional improvement in amblyopia in children, with or without coexisting ocular and medical disorders. It is important that traditional treatment had failed in all patients with hyperopic anisometropia in our study.…”