Cataract surgery in the extremely small eye: morphology, comorbidities and outcomes in 300 eyes.
Hammer Maximilian, Teich Lilly, Friedrich Maximilian, Reitemeyer Emanuel, Britz Leoni, Khoramnia Ramin, Yildirim Timur Mert, Auffarth Gerd U
AI Summary
Cataract surgery in extremely short eyes is safe and improves anterior chamber configuration, but is imprecise. Nanophthalmic eyes had compromised outcomes, yet overall, surgery provides spectacle independence.
Abstract
Background/aims: Data on morphological characteristics and outcomes of extremely short eyes undergoing cataract surgery is sparse. Thus, an in-depth characterisation of eyes implanted with a high-power intraocular lens (IOL) (>30 dioptres) was performed.
Methods
In this retrospective cohort study from January 2009 to October 2023, 300 eyes of 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL>30D were included. Eyes were categorised into the morphologies of nanophthalmos (N), relative anterior microphthalmos (RAM) and high or low/moderate hyperopia (HH and MH). Comorbidities, intraoperative and postoperative complications, preoperative and postoperative refraction and visual outcomes were investigated.
Results
Mean preoperative spherical equivalent (SE) was +6±2.85 D. The mean axial length was 20.68±0.92 mm. 19.3%, 45.3%, 22.7% and 12.7% of the studied eyes were categorised as MH, HH, N and RAM, respectively. Amblyopia (14.7%), previous strabismus surgery (7.3%), glaucoma (12.7%) and previous iridotomy (9.4%) were prevalent. Postoperative SE was -0.42±1.56 D. Preoperative Corrected Distance Visual Acuity (CDVA) and postoperative Uncorrected Distance Visual Acuity (UDVA) were not significantly different (0.34±0.39 Logarithm of the Minimum Angle of Resolution (logMAR) vs 0.47±0.38 logMAR, respectively, p=0.47), postoperative CDVA was slightly improved (0.28±0.31 logMAR, p=0.02). The narrow anterior chamber angle was significantly alleviated, posterior capsule rupture rates (3%) were within previously reported ranges.
Conclusions
Lens surgery is safe, improves the anterior chamber situation but is rather imprecise in extremely short eyes. Of all subtypes, nanophthalmic eyes showed compromised outcomes. Postoperative CDVA is only slightly improved to preoperative CDVA, while postoperative UDVA closely resembles preoperative CDVA. Surgery thus provides spectacle independence leading to good patient satisfaction.
MeSH Terms
Shields Classification
Key Concepts6
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, the narrow anterior chamber angle was significantly alleviated post-surgery.
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, postoperative Corrected Distance Visual Acuity (CDVA) was slightly improved (0.28±0.31 logMAR) compared to preoperative CDVA (0.34±0.39 logMAR, p=0.02).
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, nanophthalmic eyes showed compromised outcomes compared to other subtypes.
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, the mean axial length was 20.68±0.92 mm.
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, glaucoma was prevalent in 12.7% of the studied eyes.
In a retrospective cohort study of 300 eyes from 191 patients undergoing cataract surgery with extremely short axial length requiring the implantation of a high power IOL >30D, posterior capsule rupture rates were 3%.
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