Staged Surgical Management Of Progressive Hyperopia After Radial Keratotomy

To illustrate the staged surgical management of severe progressive hyperopia after radial keratotomy (RK), combining corneal cerclage and subsequent cataract surgery with small-aperture intraocular lens implantation to achieve long-term refractive stability and functional vision.

Cornea department, Centro de Oftalmología Barraquer, Barcelona (Spain)

A 58-year-old patient with prior RK presented with severe progressive hyperopia in the left eye (OS), reaching +10.00 D, with marked central corneal flattening on corneal topography. Corrected distance visual acuity (CDVA) was 0.4 with high hyperopic correction. Visual quality was further affected by higher-order aberrations induced by radial incisions.

Due to significant biomechanical weakening, corneal cerclage using Greene’s Lasso technique was performed. The circumferential compression of the peripheral cornea induced central steepening, aiming to restore a more physiological corneal architecture. Intraoperative keratometry with a portable keratometer showed an increase of 9 D in central keratometry. Based on intraoperative keratoscopy findings, an additional suture at 6 o’clock was placed to compensate for astigmatism.

Postoperatively, uncorrected distance visual acuity improved to 0.6, and best corrected visual acuity did not improve further with optical correction.

At one-year follow-up, hyperopia had increased by +1.50 D. As the patient was also developing an early cataract, phacoemulsification was performed with implantation of a small-aperture IC-8 intraocular lens to enhance depth of focus and reduce the impact of residual corneal irregularity.

At more than one year after cataract surgery, the patient maintains 0.6 uncorrected visual acuity at far, intermediate and near distances in the left eye, with good subjective visual quality and refractive stability.

Late hyperopic shift after RK reflects progressive biomechanical corneal instability rather than a purely refractive error. Corneal cerclage can partially restore corneal shape by peripheral compression and central steepening, improving optical conditions and aiding intraocular lens calculation. In selected patients with recurrent hyperopia and early cataract, staged management combining biomechanical stabilization and small-aperture IOL implantation may optimize long-term outcomes in complex post-RK patients.