Hyperopic shift after refractive lens surgery in a patient with prior history of radial keratotomy

Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.