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Managing dense cataracts in small eyes: a surgical challenge

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Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Monday 09/10/2017 | 14:30-16:00

Paper Time: 15:30

Venue: Meeting Center Room I

First Author: : D.Silva PORTUGAL

Co Author(s): :    A. Lopes   C. Pedrosa   P. Pego   S. Pinto   C. Vendrell   I. Prieto     

Abstract Details


Cataract surgery in nanophthalmic eyes has been associated with a higher rate of complications such as uveal effusion, choroidal and vitreous haemorrhage. Special features of these eyes such as the shallow anterior chamber (AC), make them prone to intraoperative complications. We present in video our surgical experience and techniques used in these cases, highlighting the critical steps and the methods used to enhance the AC working space and maintaining its depth stability during the surgical procedure.


Hospital Professor Doutor Fernando da Fonseca, Lisbon, Portugal


We present a series of 14 eyes of 7 patients with dense cataracts and axial lengths of 16,00-20,00 mm. Median distance corrected visual acuity (DCVA) was 20/100. Intraocular pressure (IOP) was high in two eyes. Surgeries were performed under general anaesthesia with prior vortex veins massage. The anterior capsulorhexis was performed through a 1mm side port before main incision. Microcoaxial phacoemulsification (2.2mm) with active fluidic (Centurion) was used in most cases. Bimanual irrigation/aspiration was performed carefully attending to floppy capsular bags followed by a single-piece hydrophilic acrylic intraocular lens (IOL) implantation with power range of 48-52D.


All surgeries were completed and, in most cases, AC depth and working space were kept stable. Intraoperatively, we registered two cases of iris prolapse; difficulties in cortical aspiration due to floppy capsular bags; two eyes with capsular tension rings insertion in the bag prior to IOL implantation; and iris retractors were needed in two eyes. 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 DCVA and were satisfied with the surgical results.


Although cataract surgery in nanophthalmic eyes is probably one of the most challenging procedures, in our experience, a gentle and careful surgical approach with these techniques allows a greater chance of success. Knowing the characteristics of these small eyes is therefore crucial to avoid intra-operative complications. Implantation of a single one-piece IOL provided good results in our patients, although the best power calculation formula and IOL type hasn’t been determined accounting for variable refractive results.

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