{"id":23202,"date":"2026-09-23T12:54:16","date_gmt":"2026-09-23T10:54:16","guid":{"rendered":"https:\/\/albertobellone.it\/?p=23202"},"modified":"2026-10-03T16:08:20","modified_gmt":"2026-10-03T14:08:20","slug":"hyperopia-after-radial-keratotomy","status":"publish","type":"post","link":"https:\/\/albertobellone.it\/en\/hyperopia-after-radial-keratotomy\/","title":{"rendered":"Late hyperopia after radial keratotomy: diagnosis, epidemiology, treatment"},"content":{"rendered":"<p><em>Diagnosis, epidemiology, treatment<\/em><br \/>\n<strong>Dr Alberto Bellone, ophthalmic surgeon<\/strong><\/p>\n<p>In the 1980s and 1990s, many short-sighted people chose radial keratotomy. It was the only refractive surgery available, and for years it worked. Those people are now in their fifties, sixties and seventies. And many of them come back to the ophthalmologist with a problem nobody had fully anticipated: they have become <a href=\"https:\/\/albertobellone.it\/en\/hypermetropia-en\/\">long-sighted<\/a>.<\/p>\n<p>This article explains why it happens, how common it is, how I diagnose it and how I treat it.<\/p>\n<h2>What radial keratotomy did to the cornea<\/h2>\n<p>Radial keratotomy (RK) corrected myopia with deep radial incisions in the cornea, like the spokes of a wheel, leaving a central zone of 3-4 mm untouched. The incisions weakened the periphery. The periphery bulged. The centre flattened. Myopia decreased.<\/p>\n<p>The same mechanism now creates the problem. A cornea with eight or sixteen incisions cut to 90-100% of its thickness never recovers its original rigidity. It goes on flattening, slowly, for years. And a cornea that flattens pushes the refraction towards hyperopia.<\/p>\n<p>Two further effects add to this: vision that fluctuates through the day, with a steeper cornea in the morning and a flatter one in the evening, and an irregular astigmatism that no spectacle fully corrects.<\/p>\n<h2>How common it is: the numbers<\/h2>\n<p>The reference remains the PERK study, the only prospective multicentre trial with a standardised technique, funded by the US National Eye Institute and followed for ten years [1,2].<\/p>\n<ul>\n<li>Between six months and ten years after surgery, <strong>43% of eyes<\/strong> shifted towards hyperopia by at least one dioptre.<\/li>\n<li>At ten years, <strong>36% of eyes were frankly hyperopic<\/strong>.<\/li>\n<li>Mean refraction moved from \u22120.36 D at six months to +0.51 D at ten years.<\/li>\n<li>The shift is fastest in the first two years (+0.21 D\/year) and then slows (+0.06 D\/year), but it <strong>does not stop<\/strong>: it continued throughout the ten years of the study, with no plateau.<\/li>\n<li>It could not be predicted from the patient&#8217;s age or from the initial result. It was more frequent with a small optical zone, long incisions and high attempted corrections.<\/li>\n<\/ul>\n<p>Other series agree. Deitz and Sanders were the first to describe the phenomenon, which they called &#8220;progressive hyperopia&#8221;: a third of eyes had shifted by more than one dioptre as early as one to three years, and no preoperative or surgical variable could account for it [3]. In the Casebeer series, eyes operated for myopia above 6 dioptres were the least stable, still shifting by almost half a dioptre a year in the second and third year [4]. An Italian series from Bologna, using a 4-8 incision technique, is more favourable, yet still finds a hyperopic shift of more than half a dioptre in 40% of eyes at eight years [5].<\/p>\n<p>Beyond ten years there are no prospective cohorts. There are cases followed for twenty years and more, and the clinical experience of anyone who sees these patients every week: the shift goes on for decades. The figure is not quantified, but it is consistent with the biomechanics.<\/p>\n<figure style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-large\" src=\"https:\/\/albertobellone.it\/wp-content\/uploads\/2026\/09\/A1-FIG1-OD-differenziale-2021-2026.png\" alt=\"Right eye corneal topography after radial keratotomy: 2021 and 2026 tangential maps and difference map\" width=\"1024\" \/><figcaption class=\"wp-caption-text\">Figure 1. Right eye, corneal topography (Sirius, CSO) more than thirty years after radial keratotomy. Top: anterior tangential map from 17 September 2026 (left) and 1 October 2021 (right), on the same colour scale. Both show the shape typical of a cornea that has undergone radial keratotomy: a flat centre (green) surrounded by a steeper ring (yellow and red), where the incisions have let the periphery bulge. Central simulated keratometry moves from 39.65 \/ 39.97 D in 2021 to 38.58 \/ 38.84 D in 2026. Bottom: difference map, 2026 exam minus 2021 exam. The central zone is green-blue, i.e. negative, with values between roughly \u22120.8 and \u22121.4 D: over five years the centre of the cornea has flattened further. All else being equal, a flatter centre means a more hyperopic refraction. The 2026 exam was taken in the morning (10 am) and the 2021 exam in the evening (7 pm): since a cornea operated with radial keratotomy is steeper in the morning, the true difference is, if anything, underestimated.<\/figcaption><\/figure>\n<figure style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-large\" src=\"https:\/\/albertobellone.it\/wp-content\/uploads\/2026\/09\/A1-FIG2-OS-differenziale-2021-2026.png\" alt=\"Left eye corneal topography after radial keratotomy: 2021 and 2026 tangential maps and difference map\" width=\"1024\" \/><figcaption class=\"wp-caption-text\">Figure 2. Left eye of the same person, same comparison as Figure 1 (Sirius, CSO). Top: anterior tangential map from 17 September 2026 (left) and 1 October 2021 (right). Central simulated keratometry moves from 39.13 \/ 39.33 D to 38.22 \/ 38.76 D. Bottom: difference map, 2026 minus 2021, with a negative central zone between roughly \u22120.4 and \u22121.8 D. The very high values along the upper edge of the difference map are an edge artefact caused by the eyelid and should not be read as a change in the cornea. The picture is similar to that of the right eye: both eyes are flattening, with different magnitude and distribution.<\/figcaption><\/figure>\n<figure style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-large\" src=\"https:\/\/albertobellone.it\/wp-content\/uploads\/2026\/09\/A1-FIG3-OD-confronto-2021-2022-2026.png\" alt=\"Right eye after radial keratotomy: 2021, 2022 and 2026 tangential maps and difference maps\" width=\"1024\" \/><figcaption class=\"wp-caption-text\">Figure 3. The same right eye in three consecutive exams (Sirius, CSO). Top, from left: anterior tangential maps from 17 September 2026, 17 December 2022 and 1 October 2021, on the same colour scale; central simulated keratometry is 38.58 \/ 38.84 D, 39.12 \/ 39.42 D and 39.65 \/ 39.97 D respectively. Bottom: the three difference maps, 2026 minus 2022 (left), 2026 minus 2021 (centre) and 2022 minus 2021 (right). In all three the centre is green-blue, i.e. negative: flattening is present in each interval, is larger over the longer interval, and shows no sign of stopping. This is what the literature describes as a shift that continues without reaching a plateau.<\/figcaption><\/figure>\n<figure style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"size-large\" src=\"https:\/\/albertobellone.it\/wp-content\/uploads\/2026\/09\/A1-FIG3b-OS-confronto-2021-2022-2026.png\" alt=\"Left eye after radial keratotomy: 2021, 2022 and 2026 tangential maps and difference maps\" width=\"1024\" \/><figcaption class=\"wp-caption-text\">Figure 4. Left eye in three consecutive exams (Sirius, CSO): anterior tangential maps from 17 September 2026, 17 December 2022 and 1 October 2021, with the three difference maps below (2026 minus 2022, 2026 minus 2021, 2022 minus 2021). Central simulated keratometry is 38.22 \/ 38.76 D, 38.77 \/ 39.16 D and 39.13 \/ 39.33 D. As in the right eye, the centre of the difference maps is negative in every interval. The high values along the upper edge are eyelid artefacts.<\/figcaption><\/figure>\n<h2>When it appears<\/h2>\n<p>The literature measures the shift in years from surgery, not in the patient&#8217;s age. It starts early, within the first two years, and carries on. In practice the patient notices it later, typically after 45, for a simple reason: as long as the crystalline lens can accommodate, a small hyperopia is compensated and goes unseen. When presbyopia arrives, the compensation fails. The patient discovers, all at once, the hyperopia accumulated over twenty years.<\/p>\n<p>So it is not a second disease appearing at fifty. It is a disease that began at twenty-five and stayed silent for as long as the lens concealed it.<\/p>\n<h2>How I make the diagnosis<\/h2>\n<p>The diagnosis is clinical and instrumental at the same time. I look for four things.<\/p>\n<ul>\n<li><strong>Refraction, under cycloplegia<\/strong>. In these eyes the manifest refraction often underestimates the hyperopia, because the patient still accommodates as much as they can. Cycloplegia tells the truth.<\/li>\n<li><strong>Diurnal fluctuation<\/strong>. I measure refraction and topography in the morning and in the late afternoon. In symptomatic PERK patients the cornea steepens by about half a dioptre from morning to evening, with a matching myopic shift in refraction [6,7]. A difference of that order is the signature of an unstable cornea. It must be documented before any surgical decision, because it changes the target.<\/li>\n<li><strong>Corneal tomography<\/strong>. For the curvature map, the irregular astigmatism, the higher-order aberrations and the thickness. I count the incisions, assess their depth and look for gaping ones or ones with epithelial ingrowth, which make the cornea even less reliable.<\/li>\n<li><strong>The lens and the anterior chamber<\/strong>. These two findings decide the treatment. I assess lens clarity at the slit lamp and with densitometry, anterior chamber depth on biometry, endothelial cell count and white-to-white diameter.<\/li>\n<\/ul>\n<h2>Options I use little, or not at all<\/h2>\n<p><strong>Spectacles and contact lenses<\/strong>. They remain the first answer. Rigid or scleral lenses give the best visual quality on an irregular cornea. But many patients had RK precisely so as not to wear lenses, and at sixty, tolerance is lower.<\/p>\n<p><strong>Hyperopic laser<\/strong>. Hyperopic LASIK and PRK have been used. The results are less stable and less predictable than on a virgin cornea, and the ablation acts on a cornea that is already flattening on its own [8]. It does not address the problem where the problem arises.<\/p>\n<p><strong>Cross-linking<\/strong>. It is the most logical idea: stiffen the cornea to stop the shift. But the literature is thin, all small series with follow-up under one year and fewer than forty eyes in total [9,10,11]. The most solid signal concerns a reduction in diurnal fluctuation. On everything else the answer is negative: cross-linking flattens the cornea by a further dioptre or so, and therefore <strong>increases<\/strong> the hyperopia rather than correcting it, and there is no evidence that it halts progression. I consider it only as a stabilising step in a patient who is very symptomatic from fluctuation, ahead of lens surgery. It is not a solution for the hyperopia.<\/p>\n<p><strong>Corneal sutures<\/strong>. Concentric sutures reduce hyperopia by steepening the centre. They work, but they regress and need managing over time. I reserve them for selected cases.<\/p>\n<h2>How I treat<\/h2>\n<p>A post-RK cornea is not a good candidate for further surgery. It is unstable and irregular, and any procedure that touches it inherits that instability. My strategy is therefore to <strong>leave the cornea alone and correct the hyperopia inside the eye<\/strong>. The choice depends on the lens.<\/p>\n<h3>Clear lens and adequate anterior chamber: phakic ICL<\/h3>\n<p>If the crystalline lens is still clear and the anterior chamber is deep enough, I implant a hyperopic ICL, a <a href=\"https:\/\/albertobellone.it\/en\/phakic-lenses\/\">phakic lens<\/a> placed in the posterior chamber. It sits between the iris and the lens, corrects the hyperopia and, in its toric version, the regular astigmatism. The natural lens stays in place and residual accommodation is preserved.<\/p>\n<p>The conditions I set:<\/p>\n<ul>\n<li>a clear lens, with no early cataract;<\/li>\n<li>adequate anterior chamber depth, measured from the endothelium, according to the safety criteria established for phakic lenses;<\/li>\n<li>an endothelial cell count adequate for age;<\/li>\n<li>a refraction that is stable through the day or, if it fluctuates, a target chosen on the most representative measurement.<\/li>\n<\/ul>\n<p>The literature consists of small series, but it is consistent: correcting post-RK hyperopia with an ICL is effective and predictable, with no intraoperative complications reported, and spherical equivalents moving from around +5 D to close to zero [12,13,14]. The conceptual advantage is clear: the cornea is left untouched, and the lens is reversible.<\/p>\n<p>The limit is equally clear: an ICL corrects today&#8217;s hyperopia; it does not stop tomorrow&#8217;s shift. The cornea will go on flattening. I say this to the patient before, not after. In an eye past fifty, the phakic lens is often a bridge, carrying the patient through to lens surgery with good vision in the meantime.<\/p>\n<h3>Clear lens but shallow anterior chamber: refractive lens exchange with an IC-8<\/h3>\n<p>This is the most delicate case, and more common than one might think: a patient of 50-55, lens still clear, significant hyperopia, and an anterior chamber that will not safely take a phakic lens. Here lens extraction is no longer cataract surgery. It is refractive surgery on a healthy lens, and it must be discussed as such.<\/p>\n<p>Three reasons make it reasonable. At that age the residual accommodation is a dioptre or little more: in a hyperopic, fluctuating eye the lens is contributing almost nothing, and the cost of removing it is low. That lens will have to come out anyway within ten or fifteen years: doing it now avoids a second operation on a cornea that will have deteriorated in the meantime, and puts the pinhole to work at once against irregular astigmatism and diurnal fluctuation. And if the chamber is shallow because the lens has thickened, extraction solves that too.<\/p>\n<p>It must be said plainly that in this situation the literature does not exist: the IC-8 series in post-RK corneas concern eyes with cataract [15,17,18]. In a fifty-year-old with a clear lens the indication is a reasoned extrapolation, outside the lens&#8217;s registered indications, and the informed consent has to say so.<\/p>\n<p>The conditions I set, in order of importance:<\/p>\n<ul>\n<li><strong>The retina<\/strong>. These patients were myopic before their RK, and lens extraction in a myopic eye carries a risk of retinal detachment that is not negligible [20]. The IC-8 mask also makes examination of the retinal periphery, and any vitreoretinal surgery, less straightforward: feasible, but not easy [21]. The periphery must be thoroughly examined, the state of the vitreous known, and any prophylactic laser done beforehand.<\/li>\n<li><strong>The pupil<\/strong>. The opaque ring of the IC-8 has an outer diameter of 3.23 mm. With a photopic pupil under 3 mm the light entering the eye falls sharply; with a wide mesopic pupil the patient loses contrast at night. I measure the pupil under both conditions before deciding, and I ask how much they drive after dark.<\/li>\n<li><strong>The corneal centre<\/strong>. The RK optical zone must be clean: a scar or an incision reaching into the central 1.6 mm cancels the benefit of the aperture.<\/li>\n<li><strong>One eye or two<\/strong>. The registered indication is unilateral, in the non-dominant eye, with a \u22120.75 D target and a monofocal aimed at emmetropia in the dominant eye. In a post-RK patient, however, the dominant eye with a monofocal keeps all of its aberrations. Bilateral implantation is off-label: it gives more near vision, but more haloes and lower satisfaction [22,23]. My sequence is to operate on the non-dominant eye first and decide on the second eye after four to six weeks, according to how the patient tolerates the dimming.<\/li>\n<\/ul>\n<p>An alternative I keep on the table is the light-adjustable lens, which allows the refraction to be corrected after surgery: the largest series to date in post-RK eyes, 94 eyes, reports 88% within half a dioptre of target at final lock-in [24]. It does nothing for aberrations or fluctuation, so in a very irregular cornea the IC-8 remains the more coherent choice; in a regular but unpredictable cornea the adjustable lens is a strong option. In different eyes of the same patient the two can even be combined.<\/p>\n<h3>Cataractous lens: lens extraction with an IC-8<\/h3>\n<p>If the lens shows even an early cataract, I remove it and implant an intraocular lens. The same conditions as in the previous section apply, with one difference: here the extraction is necessary in any case, and the only choice is the lens. In these eyes the choice of lens matters more than the technique.<\/p>\n<p>Diffractive multifocal lenses are to be avoided: they add their own aberrations to those of an already irregular cornea. The aspheric monofocal is the traditional choice, but it leaves every corneal aberration in place. This is why, in a post-RK cornea, I prefer the small-aperture <a href=\"https:\/\/albertobellone.it\/en\/ic8-by-bl-the-only-lens-for-correcting-vision-defects-related-to-corneal-alterations\/\"><strong>IC-8<\/strong><\/a> lens.<\/p>\n<p>The IC-8 carries an opaque mask with a central 1.36 mm aperture. It works like a pinhole: it lets through only the central rays, filters out the peripheral rays deflected by the incisions, and returns a sharper image at every distance. It tolerates up to one dioptre of refractive error and one and a half of astigmatism without losing acuity. That is exactly what an eye needs when the lens calculation is difficult and the refraction will keep moving.<\/p>\n<p>The literature is recent and growing. A prospective series from Munich implanted the IC-8 in severely irregular corneas, including post-RK eyes, with improved corrected acuity in almost every patient [15]; a 2022 systematic review gathers 22 studies and 460 eyes, with good vision at all distances and few complications [16]; a series from Florence reports improved acuity and quality of vision in eyes that were mostly post-RK, with no visual field defects [17]; and a 2026 Australian series of 67 eyes with irregular corneas, post-RK among them, reports uncorrected acuity of 6\/12 or better in 75-100% of eyes depending on the underlying condition [18].<\/p>\n<p>Three precautions I always apply in this surgery:<\/p>\n<ul>\n<li>lens power calculated with formulas designed for post-refractive corneas and aimed slightly myopic, because a calculation targeting emmetropia in these eyes ends up hyperopic in the great majority of cases [19];<\/li>\n<li>small surgical incisions placed between the RK scars, never across them, because the old incisions can reopen;<\/li>\n<li>the patient is told that the refraction may change again in the years ahead, and that a small residual correction is possible.<\/li>\n<\/ul>\n<h2>What this changes in practice<\/h2>\n<p>Post-RK hyperopia is neither a rare complication nor a surprise: it affects almost half of the eyes operated on, and whoever has it today will have more of it tomorrow. The diagnosis needs a cycloplegic refraction and two measurements in one day. The treatment does not go through the cornea. It goes through the lens: an ICL if the lens is clear and there is room; lens extraction with an IC-8 if there is no room, or if the lens has begun to cloud.<\/p>\n<p>A patient who had RK thirty years ago has already asked a great deal of their cornea. I do not ask it for more.<\/p>\n<p class=\"ab-disclaimer\"><em>The information in this article is for general guidance and does not replace an eye examination. Every treatment decision should follow a complete assessment of the eye.<\/em><\/p>\n<h2>References<\/h2>\n<ol class=\"ab-refs\">\n<li>Waring GO 3rd, Lynn MJ, McDonnell PJ; PERK Study Group. Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study 10 years after surgery. <em>Arch Ophthalmol<\/em>. 1994;112(10):1298-1308. <a href=\"https:\/\/doi.org\/10.1001\/archopht.1994.01090220048022\" rel=\"nofollow\">doi:10.1001\/archopht.1994.01090220048022<\/a><\/li>\n<li>Waring GO 3rd, Lynn MJ, Nizam A, et al. Results of the Prospective Evaluation of Radial Keratotomy (PERK) Study five years after surgery. <em>Ophthalmology<\/em>. 1991;98(8):1164-1176. <a href=\"https:\/\/doi.org\/10.1016\/s0161-6420(91)32156-0\" rel=\"nofollow\">doi:10.1016\/s0161-6420(91)32156-0<\/a><\/li>\n<li>Deitz MR, Sanders DR, Raanan MG. Progressive hyperopia in radial keratotomy. Long-term follow-up of diamond-knife and metal-blade series. <em>Ophthalmology<\/em>. 1986;93(10):1284-1289. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/3785887\/\" rel=\"nofollow\">PMID 3785887<\/a><\/li>\n<li>Werblin TP, Stafford GM. Hyperopic shift after refractive keratotomy using the Casebeer System. <em>J Cataract Refract Surg<\/em>. 1996;22(8):1030-1036. <a href=\"https:\/\/doi.org\/10.1016\/s0886-3350(96)80115-5\" rel=\"nofollow\">doi:10.1016\/s0886-3350(96)80115-5<\/a><\/li>\n<li>Scorolli L, Scorolli L, Scalinci SZ, Savini G, Meduri R. Hyperopic shift after 4-8 incision radial keratotomy: eight-year follow-up. <em>Eur J Ophthalmol<\/em>. 1996;6(4):351-355. <a href=\"https:\/\/doi.org\/10.1177\/112067219600600401\" rel=\"nofollow\">doi:10.1177\/112067219600600401<\/a><\/li>\n<li>McDonnell PJ, Nizam A, Lynn MJ, Waring GO 3rd; PERK Study Group. Morning-to-evening change in refraction, corneal curvature, and visual acuity 11 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study. <em>Ophthalmology<\/em>. 1996;103(2):233-239. <a href=\"https:\/\/doi.org\/10.1016\/s0161-6420(96)30711-2\" rel=\"nofollow\">doi:10.1016\/s0161-6420(96)30711-2<\/a><\/li>\n<li>Kemp JR, Martinez CE, Klyce SD, et al. Diurnal fluctuations in corneal topography 10 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study. <em>J Cataract Refract Surg<\/em>. 1999;25(7):904-910. <a href=\"https:\/\/doi.org\/10.1016\/s0886-3350(99)00090-5\" rel=\"nofollow\">doi:10.1016\/s0886-3350(99)00090-5<\/a><\/li>\n<li>Colombo-Barboza GN, Rodrigues PF, Colombo-Barboza FDP, et al. Radial keratotomy: background and how to manage these patients nowadays. <em>BMC Ophthalmol<\/em>. 2024;24(1):9. <a href=\"https:\/\/doi.org\/10.1186\/s12886-023-03261-0\" rel=\"nofollow\">doi:10.1186\/s12886-023-03261-0<\/a><\/li>\n<li>Elbaz U, Yeung SN, Ziai S, et al. Collagen crosslinking after radial keratotomy. <em>Cornea<\/em>. 2014;33(2):131-136. <a href=\"https:\/\/doi.org\/10.1097\/ICO.0000000000000044\" rel=\"nofollow\">doi:10.1097\/ICO.0000000000000044<\/a><\/li>\n<li>Fuentes-P\u00e1ez G, Castanera F, G\u00f3mez de Salazar-Martinez R, et al. Corneal cross-linking in patients with radial keratotomy: short-term follow-up. <em>Cornea<\/em>. 2012;31(3):232-235. <a href=\"https:\/\/doi.org\/10.1097\/ICO.0b013e31821f28bb\" rel=\"nofollow\">doi:10.1097\/ICO.0b013e31821f28bb<\/a><\/li>\n<li>Mazzotta C, Baiocchi S, Denaro R, Tosi GM, Caporossi T. Corneal collagen cross-linking to stop corneal ectasia exacerbated by radial keratotomy. <em>Cornea<\/em>. 2011;30(2):225-228. <a href=\"https:\/\/doi.org\/10.1097\/ICO.0b013e3181e16de5\" rel=\"nofollow\">doi:10.1097\/ICO.0b013e3181e16de5<\/a><\/li>\n<li>Srinivasan S, Drake A, Herzig S. Early experience with implantable collamer lens in the management of hyperopia after radial keratotomy. <em>Cornea<\/em>. 2008;27(3):302-304. <a href=\"https:\/\/doi.org\/10.1097\/ICO.0b013e31815ea268\" rel=\"nofollow\">doi:10.1097\/ICO.0b013e31815ea268<\/a><\/li>\n<li>Kamiya K, Shimizu K. Implantable Collamer lens for hyperopia after radial keratotomy. <em>J Cataract Refract Surg<\/em>. 2008;34(8):1403-1404. <a href=\"https:\/\/doi.org\/10.1016\/j.jcrs.2008.03.045\" rel=\"nofollow\">doi:10.1016\/j.jcrs.2008.03.045<\/a><\/li>\n<li>Mart\u00edn-Escuer B, Alfonso JF, Esteve-Taboada JJ, Fern\u00e1ndez-Vega Cueto L, Mont\u00e9s-Mic\u00f3 R. Implantation of implantable collamer lenses after radial keratotomy. <em>J Refract Surg<\/em>. 2017;33(6):395-398. <a href=\"https:\/\/doi.org\/10.3928\/1081597X-20170426-01\" rel=\"nofollow\">doi:10.3928\/1081597X-20170426-01<\/a><\/li>\n<li>Shajari M, Mackert MJ, Langer J, et al. Safety and efficacy of a small-aperture capsular bag-fixated intraocular lens in eyes with severe corneal irregularities. <em>J Cataract Refract Surg<\/em>. 2020;46(2):188-192. <a href=\"https:\/\/doi.org\/10.1097\/j.jcrs.0000000000000045\" rel=\"nofollow\">doi:10.1097\/j.jcrs.0000000000000045<\/a><\/li>\n<li>S\u00e1nchez-Gonz\u00e1lez JM, S\u00e1nchez-Gonz\u00e1lez MC, De-Hita-Cantalejo C, Ballesteros-S\u00e1nchez A. Small aperture IC-8 extended-depth-of-focus intraocular lens in cataract surgery: a systematic review. <em>J Clin Med<\/em>. 2022;11(16):4654. <a href=\"https:\/\/doi.org\/10.3390\/jcm11164654\" rel=\"nofollow\">doi:10.3390\/jcm11164654<\/a><\/li>\n<li>Franco F, Branchetti M, Vicchio L, et al. Implantation of a small aperture intraocular lens in eyes with irregular corneas and higher order aberrations. <em>J Ophthalmic Vis Res<\/em>. 2022;17(3):317-323. <a href=\"https:\/\/doi.org\/10.18502\/jovr.v17i3.11568\" rel=\"nofollow\">doi:10.18502\/jovr.v17i3.11568<\/a><\/li>\n<li>Samarawickrama C, Khan M. Implantation of small-aperture IOL in patients with cataract and preexisting corneal comorbidities. <em>Clin Ophthalmol<\/em>. 2026;20:588341. <a href=\"https:\/\/doi.org\/10.2147\/OPTH.S588341\" rel=\"nofollow\">doi:10.2147\/OPTH.S588341<\/a><\/li>\n<li>Chen L, Mannis MJ, Salz JJ, Garcia-Ferrer FJ, Ge J. Analysis of intraocular lens power calculation in post-radial keratotomy eyes. <em>J Cataract Refract Surg<\/em>. 2003;29(1):65-70. <a href=\"https:\/\/doi.org\/10.1016\/s0886-3350(02)01693-0\" rel=\"nofollow\">doi:10.1016\/s0886-3350(02)01693-0<\/a><\/li>\n<li>Colin J, Robinet A, Cochener B. Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. <em>Ophthalmology<\/em>. 1999;106(12):2281-2284. <a href=\"https:\/\/doi.org\/10.1016\/S0161-6420(99)90526-2\" rel=\"nofollow\">doi:10.1016\/S0161-6420(99)90526-2<\/a><\/li>\n<li>Srinivasan S, Khoo LW, Koshy Z. Posterior segment visualization in eyes with small-aperture intraocular lens. <em>J Refract Surg<\/em>. 2019;35(8):538-542. <a href=\"https:\/\/doi.org\/10.3928\/1081597X-20190710-01\" rel=\"nofollow\">doi:10.3928\/1081597X-20190710-01<\/a><\/li>\n<li>Dick HB, Elling M, Schultz T. Binocular and monocular implantation of small-aperture intraocular lenses in cataract surgery. <em>J Refract Surg<\/em>. 2018;34(9):629-631. <a href=\"https:\/\/doi.org\/10.3928\/1081597X-20180716-02\" rel=\"nofollow\">doi:10.3928\/1081597X-20180716-02<\/a><\/li>\n<li>Ang RE. Visual performance of a small-aperture intraocular lens: first comparison of results after contralateral and bilateral implantation. <em>J Refract Surg<\/em>. 2020;36(1):12-19. <a href=\"https:\/\/doi.org\/10.3928\/1081597X-20191114-01\" rel=\"nofollow\">doi:10.3928\/1081597X-20191114-01<\/a><\/li>\n<li>Webster M, Baartman B, Jones M, et al. Light-adjustable lens in eyes with a history of radial keratotomy. <em>J Cataract Refract Surg<\/em>. 2025;51(3):243-248. <a href=\"https:\/\/doi.org\/10.1097\/j.jcrs.0000000000001596\" rel=\"nofollow\">doi:10.1097\/j.jcrs.0000000000001596<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Diagnosis, epidemiology, treatment Dr Alberto Bellone, ophthalmic surgeon In the 1980s and 1990s, many short-sighted people chose radial keratotomy. It was the only refractive surgery available, and for years it worked. Those people are now in their fifties, sixties and seventies. And many of them come back to the ophthalmologist with a problem nobody had [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":23455,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[605],"tags":[],"class_list":["post-23202","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-visual-defects"],"_links":{"self":[{"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/posts\/23202","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/comments?post=23202"}],"version-history":[{"count":2,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/posts\/23202\/revisions"}],"predecessor-version":[{"id":23204,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/posts\/23202\/revisions\/23204"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/media\/23455"}],"wp:attachment":[{"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/media?parent=23202"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/categories?post=23202"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/albertobellone.it\/en\/wp-json\/wp\/v2\/tags?post=23202"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}