Refractive Surgery for Hyperopia

ABSTRACT PURPOSE: To determine the efficacy, stability, and predictability of refractive surgery for hyperopia using four different procedures: photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), implantation of a phakic intraocular lens (PIOL), and removing the transparent lens with IOL implantation. METHODS: We operated on 184 eyes with hyperopia; 56 eyes had less than +2.00 D (low hyperopia), 62 eyes had +2.00 to +5.00 D (moderate hyperopia), and 66 eyes had greater than +5.00 D (high hyperopia). In the low hyperopia group, PRK was used in 22 eyes and LASIK in 34 eyes. In the moderate hyperopia group, PRK was used in 12 eyes and LASIK in 33 eyes, PIOL implantation in 12 eyes, and transparent lens extraction with IOL implantation in 5 eyes. In the high hyperopia group, PRK was used in 7 eyes, LASIK in 12 eyes, PIOL implantation in 21 eyes, and extraction of transparent lens with IOL implantation in 26 eyes. We used the Nidek EC5000 excimer laser and with the Moria LASIK Evolution microkeratome. The transparent lens was removed by phacoemulsification, and the Phacoprofile Storz IOL with optical power from 28.00 to 36.00 D was implanted. The PIOLs were made of a collagen copolymer with a focal power from +6.00 to +12.00 D. RESULTS AND CONCLUSION: Refraction and visual results depended on amount of baseline hyperopia and age of the patient. For young patients (35 years old or less) with normal accommodation and low or moderate hyperopia, PRK and LASIK were our methods of choice. However, after LASHL stabilization of refraction occurred faster (3 to 12 weeks) compared to PRK, where changes in refraction were noted from 8 to 12 months after surgery. In patients with hyperopia more than +5.00 D, we prefer intraocular methods of correction: phakic IOL implantation for young patients and removing the transparent lens with IOL implantation in patients with presbyopia or anatomical tendency for development of closedangle glaucoma. [J Refract Surg 2000;16(suppl): S242-S246]