Surgical considerations in hyperopic cataract patients: optimizing outcomes and reducing complications

Cataract surgery in hyperopic individuals presents unique anatomical and physiological challenges, including shallow anterior chambers, increased lens vaults, and a higher risk of intraoperative complications. This review explores key considerations for preoperative assessment, surgical planning, and intraoperative techniques tailored to hyperopic eyes. Preoperative evaluation involves identifying systemic and ocular risk factors, such as alpha-1 blocker use, which may contribute to intraoperative floppy iris syndrome (IFIS). Key assessments include anterior chamber depth (ACD), corneal endothelial integrity, and coexisting conditions like pseudoexfoliation (PXF) syndrome and angle-closure glaucoma. Intraoperative strategies focus on optimizing phacoemulsification parameters, leveraging advanced technologies such as femtosecond laser-assisted cataract surgery (FLACS), and mitigating risks of iris prolapse and endothelial damage. Proper patient positioning, strategic use of viscoelastic agents, and meticulous incision techniques are essential to ensuring safety and surgical success. Postoperative management addresses anisometropia, monitors for complications, and plans for early intervention in the fellow eye to maintain refractive balance. This comprehensive review provides evidence-based guidance to optimize surgical outcomes and minimize complications in hyperopic patients undergoing cataract surgery.