Clinical, Biometric and Visual Outcomes of Cataract Surgery in Hypermetropic Eyes

Abstract

Objective: To describe the demographic, refractive, anterior- and posterior-segment biometric, and fundus characteristics of patients with hypermetropia undergoing cataract surgery, and to report the intraoperative course, visual outcomes, and complications of surgery in this population.

Materials and Methods: This retrospective observational case series included 30 consecutive patients with hypermetropia (spherical equivalent ≥ +1.00 D) who underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Preoperative demographic data, refractive error, presenting visual acuity, cataract morphology, axial length, keratometry, anterior chamber depth, lens thickness, gonioscopic angle status, and dilated fundus findings were recorded, along with implanted IOL power, target postoperative refraction, intraoperative course, and postoperative best-corrected visual acuity (BCVA) and complications.

Results: The cohort comprised 13 males and 17 females (mean age 63 years; range 40–79), with bilateral hypermetropia in 90.0% and a mean spherical equivalent of +3.5 to +4.0 D. The mean axial length was approximately 23.0 mm, mean anterior chamber depth 2.9–3.0 mm, and mean lens thickness 4.7 mm; gonioscopy showed narrow or occludable angles in 33.4% of patients. IOL powers of +25 D or higher were required in 76.7% of eyes. Phacoemulsification with PCIOL implantation was uneventful in 86.7% of cases. Postoperatively, 70.0% of patients achieved a BCVA of 6/18 or better and 86.7% achieved 6/36 or better. Limited postoperative recovery (BCVA worse than 6/18, seen in a minority of patients) was attributable to pre-existing macular pathology, very short axial length with a crowded posterior segment, residual refractive error, and surgical complications, in roughly equal proportion.

Conclusion: Cataract surgery is highly effective in hypermetropic eyes despite the technical challenges posed by a crowded anterior segment — short axial length, increased lens thickness, shallow anterior chamber, and narrow angles. Careful preoperative biometric and gonioscopic assessment, judicious IOL formula selection, and surgical vigilance for zonular and capsular stability remain key to optimising outcomes; limited visual recovery in this population is uncommon and is more often attributable to isolated posterior-segment pathology, refractive surprise, or surgical complications than to hypermetropia itself.