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Surgical management of dense cataract in small eyes

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Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Sunday 06/09/2015 | 10:30-12:30

Paper Time: 10:42

Venue: Room 10

First Author: : C.Pedrosa PORTUGAL

Co Author(s): :    B. Feijoo   M. Mota   D. Silva   A. Lopes   I. Prieto        

Abstract Details


Cataract surgery in small eyes has been associated with higher rate of complications including uveal effusion, choroidal and vitreous hemorrhage, angle-closure glaucoma, iritis, retinal detachment and cystoid macular oedema. Besides the technical challenges related with the reduced space in the anterior chamber (AC) of these eyes, there are other features that make them prone to intraoperative complications. The authors show in video the surgical experience and techniques used in these small eyes, highlighting the critical challenging steps and the methods used to enhance the AC working space and maintain its depth stability during the surgical procedure.


Dept. of Ophthalmology, Fernando Fonseca Hospital, Lisbon, Portugal.


We present a series of 10 eyes of 6 patients with dense cataracts and axial lenghts of 16,00-20,00 mm. Preoperative best-corrected visual acuity (BCVA) average was 20/100. Intraocular pressure (IOP) was normal in all cases. Surgeries were performed under general anaesthesia with prior vortex veins massage. Anterior capsulorhexis through a 1mm side port was created before main incision opening. Microcoaxial phacoemulsification (2.2mm) with active fluidic (Centurion) was used in most cases. A careful bimanual irrigation/aspiration was performed attending to floppy capsular bags followed by a single-piece hydrophilic acrylic intraocular lens (IOL) implantation (CT Xtreme D, Zeiss) with power range 48-52D.


In most cases we were able to maintain AC stability and working space during the procedure. Intraoperatively, we registered one case of iris prolapse through main incision; some difficulties in cortical aspiration due to small and floppy capsular bags; in two eyes, capsular tension rings were inserted in the bag prior to IOL implantation. There was no need to enlarge main incision. In the immediate postoperative period we observed mostly quiet eyes, clear corneas and normal IOP. Refractive results showed some variability although it didn't exceed 3D from the target refraction. All patients improved BCVA and were satisfied with the surgical results.


Although these small eyes are probably the most challenging on which to perform cataract surgery, we believe that a careful surgical approach with these techniques allows a greater chance of success. Therefore, knowledge of small eyes features is crucial in order to face several surgery specificities. We consider that implantation of a unique IOL allows good results, although the best power calculation formula and IOL type hasn't been determined.

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