Hyperopic refractive surgery

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.