Cataract Surgery In Short Axial Length Eyes: A Case Series

Cicendo National Eye Hospital, Bandung, Indonesia.

The first case was a 30-year-old female with axial length (AL) of 19.64 mm presented with left eye immature cataract and underwent phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and sclerostomy. The second case was a 25-year-old female presenting with juvenile cataract and AL of 19.67 mm. Phacoemulsification and posterior chamber IOL implantation were then performed in the right eye. A 61-year-old female with AL of 15.77 mm and left immature senile cataract underwent phacoemulsification, posterior chamber IOL implantation, and sclerostomy. Lastly, female aged 33 years old with AL of 19.59 mm and immature presenile cataract was performed sclerostomy, phacoemulsification, and piggyback IOL implantation.

The preoperative best-corrected visual acuity (BCVA) in the four cases were 0.25, 0.125, 0.08, and 0.4 respectively. The fourth case developed an elevated postoperative intraocular pressure, reaching 42 mmHg on postoperative day 1; however, this was successfully managed with antiglaucoma therapy using topical B-blocker and oral acetazolamide, resulting in good intraocular pressure control at 15 mmHg by postoperative day 30.

Cataract surgery in eyes with short axial length presents significant challenges, including a higher risk of intraoperative and postoperative complications, and unpredictable refractive results. All cases resulted in satisfactory visual acuity, and transient elevation of intraocular pressure was effectively managed with medical therapy. Adjunctive procedures, such as sclerostomy or piggyback IOL implantation, in some of these cases highlight the importance of an individualized surgical approach based on axial length, anterior segment anatomy, and intraoperative findings to optimize outcomes in short eyes.