Cataract Surgery In Patients With Nanophthalmos. Assessment, Procedures, Complications

Cataract surgery in patients with nanophthalmos might be difficult due to some anatomical abnormalities. Such as a small cornea, thickened sclera, shallow anterior chamber, and short anterior and posterior segments but normal or enlarged lens size (increased lens-to-eye volume ratio).

Unique anatomical changes may lead to complications before, during, and after surgery regardless of the surgeon's skills. Angle-closure glaucoma, uveal effusion syndrome, and retinal detachment are the most common complications. 

In our study, we performed 11 cataract surgeries on 6 patients with nanophthalmos between 2018 and 2023. We compared the measurements of AL (axial length), refraction, best-corrected visual acuity (BCVA), and IOL power. Moreover, we described difficulties and complications during surgery and the postoperative period.

The patients' ages ranged from 23 to 76 years, with an average of 50 years. The axial length varied between 15.52-20.52. In six eyes, BCVA was better than before surgery (min. logMAR 0.1), while others had the same BCVA as before surgery. Refraction after surgery ranged from -4.00 to +5.75 diopters in four eyes, while other measurements ranged between -0.75 and +1.75. Implanted IOL power varied between 30 and 54.5 diopters. IOL was calculated using SRK/T and Barrett formulas.

Preoperatively, nd:YAG laser iridotomy was performed for four patients with angle-closure glaucoma.

Complications, such as IOP elevation with serious shallowing of the AC, occurred in two eyes during surgery, and only one eye had increased IOP postoperatively.

Cataract surgery for nanophthalmos can cause some issues during and postoperative period. Sometimes the results of visual acuity may remain unchanged before and after surgery, but on the other hand the procedure can be beneficial for angle-closure glaucoma, not to mention addressing other issues related to cataract formation and the need for heavy glasses.