Hexagonal keratotomy--should we still be trying?

I present my limited but positive experience with hexagonal keratotomy for hyperopia.

Eighteen consecutive eyes of 12 patients underwent hexagonal keratotomy during 1993. In addition to the primary procedures, 14 enhancements were required in seven eyes for both astigmatism and undercorrection. Surgical planning was based on refractive data only. All surgeries were performed by one surgeon using the open hexagonal keratotomy pattern.

The patients' average age was 56 years (range, 38 to 67 years). Fourteen eyes were corrected for emmetropia. They had an average preoperative refraction of +2.22 +/- 0.64 diopters (D) and an average postoperative refraction of +0.11 +/- 0.49 D. Four eyes were corrected for near vision (-2.00 D). They had an average preoperative refraction of -0.53 +/- 0.83 D, and postoperatively their average refraction was -1.78 +/- 0.50 D. All four could read J1 without correction postoperatively. No eye lost more than one line of spectacle-corrected visual acuity; none had a major sight-threatening complication.

Hexagonal keratotomy can correct 3.50 D or less of hyperopia. Conservative surgery with one major reoperation procedure is suggested. Because of the highly variable results noted in the literature and several reports of significant complications, I no longer perform or recommend hexagonal keratotomy.