To Describe The Clinical And Biometric Profile Of Nanophthalmos Patients And Characterise The Spectrum Of Glaucoma Presentations, Surgical Interventions, And Visual Outcomes In A Tertiary Referral Centre.

To describe the clinical and biometric profile of nanophthalmos patients and characterise the spectrum of glaucoma presentations, surgical interventions, and visual outcomes in a tertiary referral centre.

King Khaled Eye Specialist Hospital, a tertiary referral eye hospital in Riyadh, Saudi Arabia.

This retrospective case series included all nanophthalmic eyes (axial length approximately ≤20.5 mm with high hyperopia and a normal‑sized lens–cornea complex) with documented to have angle closure glaucoma.

Demographic, biometric, and clinical data were extracted from electronic medical records. Outcomes included intraocular pressure (IOP) control, cup-to-disc ratio (CDR), and best-corrected visual acuity (BCVA) at baseline and at 1 week, 3 months, 6 months, and 1 year postoperatively.

All 31 eyes presented with angle-closure glaucoma. Mean axial length was 16.43 ± 1.42 mm. Mean IOP at diagnosis was 25.7 mmHg (range 11–45 mmHg). Uveal effusion was documented in 82% of eyes. Laser peripheral iridotomy (LPI) was performed in 94% of eyes; 87% of eyes subsequently required surgical intervention, most commonly cataract extraction with posterior chamber IOL implantation (44%) or cyclodestructive procedures (19%). Mean high-plus IOL power was +41.6 D (range +30 to +55 D). Significant postoperative complications occured in (56%), including aqueous misdirection, choroidal detachment, retinal detachment, and phthisis bulbi. A second surgical procedure was required in 11 eyes (35%).

Nanophthalmos is universally associated with angle-closure glaucoma and carries a high surgical complication rate. The anatomical characteristics of extremely short axial length, shallow anterior chamber, and increased scleral thickness predispose to aqueous misdirection and choroidal effusion, demanding meticulous preoperative planning and a staged surgical approach. The high rate of secondary surgical intervention underscores the challenging nature of glaucoma management in these eyes.