Surgical Correction of Hyperopia Following Radial Keratotomy

BACKGROUND: No effective treatment for hyperopia following radial keratotomy has been described. A new surgical technique of two purse-string intrastromal sutures was investigated for correction of this hyperopia. METHODS: Eighteen radial keratotomy patients who were unhappy with uncorrected vision and who were unsatisfied with contact lens or spectacle correction, after informed consent, underwent corneal suturing. The 19 hyperopic eyes included 5 original overcorrections, 5 overcorrections after reoperation, and 9 progressive hyperopes. The refractive error ranged from +1.25 to +5.75 diopters spherical equivalent (mean +3.47 D). Presuturing uncorrected visual acuity ranged from 20/50 to 20/400 with 11 eyes (58%) 20/100 or worse. RESULTS: The follow up after double purse-string suturing averaged 24 months (range, 12 to 47 months). All patients had follow up of at least 1 year; 14 patients (74%) had follow up of 2 years or more. The change in refractive spherical equivalent following surgery averaged -3.30 D (range, -1.00 to -7.50 D). The steepening in average keratometry was 4.10 D (range, 1.00 to 8.00 D). The refraction after suturing averaged -1.12 D (range, +2.50 to -3.50 D). Uncorrected visual acuity after suturing was 20/40 or better in 14 eyes (74%), and 20/50 to 20/80 in 5 eyes (36%). There were no significant intraoperative, early or late postoperative complications. Seventeen eyes were either the same or gained 1 line of acuity; 2 eyes gained 2 lines of acuity; no eyes lost any lines of refractive Snellen acuity. CONCLUSIONS: The placement of two purse-string intrastromal sutures appears to provide significant steepening of the central cornea following excessive flattening after radial keratotomy. The steepening effect appears to remain stable with greater than 1-year follow up. This surgical technique offers an alternative to symptomatic hyperopic postradial keratotomy patients who cannot be corrected with spectacles or contact lenses.