Clear lens extraction to correct hyperopia in presbyopic eyes with or without arcuate keratotomy for pre-existing astigmatism.

This retrospective study evaluates visual (functional) and refractive outcome of correcting hyperopia (i.e. 2.5 D or more) by means of a cataract procedure and simultaneously the pre-existing clinical significant astigmatism (1.5 D or more with the rule; 1 D or more against the rule), if present, by means of an arcuate keratotomy. Nine eyes undergoing clear lens extractions with intraocular lensimplantation (IOL) in combination with arcuate keratotomy (group one) and 29 eyes without arcuate kertotomy (group two) are included in the study. The mean age at the time of surgery was 62.89 years (range, 50 to 83) in group one and 68.17 years (range, 53 to 86) in group two. For calculation of the lens power a modified SRK II program, aiming at emmetropia was used. In only one highly hyperopic patient the Holladay I formula was used to calculate two piggyback lenses. A modified Istre nomogram was used to determine the surgical parameters of the arcuate keratotomy. The Cravy formula and the Holladay, Cravy, Koch vector analysis were used to determine the change in refractive cylinder results. Patients were followed postoperatively for a mean of 2.8 months in group one and 7.5 months in group two. In group one, 6 out of 9 eyes achieved a postoperative refraction within +/- 0.5 D of intended refraction and 8 out of 9 were within +/- 1 D of intended refraction. In group two, it was 15/29 and 24/29 respectively. Postoperatively, the uncorrected visual acuity was 20/40 or better in all eyes of group one (9/9) and in 27/29 eyes of group two. None of the eyes in both groups lost two or more lines of the best corrected visual acuity. Clear lens extraction with IOL is an effective and safe procedure for the correction of hyperopia in a presbyopic age group. In combination with an arcuate keratotomy, pre-existing astigmatism can be corrected simultaneously.