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The following is a summary of “Cataract surgery in the extremely small eye: morphology, comorbidities and outcomes in 300 eyes,” published in the February 2025 issue of British Journal of Ophthalmology by Hammer et al. 

Researchers conducted a retrospective study to characterize morphological features and outcomes in eyes implanted with a high-power intraocular lens (IOL) [>30 dioptres (D)] during cataract surgery.  

They analyzed data from January 2009 to October 2023 on 300 eyes from 191 individuals who underwent cataract surgery with extremely short axial length requiring implantation of a high-power IOL (>30 D). Eyes were classified into nanophthalmos (N), relative anterior microphthalmos (RAM), and high or low/moderate hyperopia (HH and MH) and Comorbidities, intraoperative and postoperative complications, as well as preoperative and postoperative refraction and visual outcomes, were analyzed.  

The results showed a mean preoperative spherical equivalent (SE) of +6±2.85 D and an axial length of 20.68±0.92 mm. Among the studied eyes, 19.3% were classified as MH, 45.3% as HH, 22.7% as N, and 12.7% as RAM. Common conditions included amblyopia (14.7%), prior strabismus surgery (7.3%), glaucoma (12.7%), and previous iridotomy (9.4%). Postoperative SE was −0.42±1.56 D. Preoperative corrected distance visual acuity (CDVA) and postoperative uncorrected distance visual acuity (UDVA) showed no significant difference (0.34±0.39 logarithm of the minimum angle of resolution [logMAR] vs 0.47±0.38 logMAR, P =0.47). Postoperative CDVA showed slight improvement (0.28±0.31 logMAR, P =0.02). Narrow anterior chamber angles improved significantly, and posterior capsule rupture occurred in 3%, aligning with previous reports.  

Investigators concluded that lens surgery in extremely short eyes, while generally safe and improving anterior chamber conditions, yielded imprecise refractive outcomes, particularly in nanophthalmic eyes, with only marginal improvement in CDVA, but provided spectacle independence and patient satisfaction. 

Source: bjo.bmj.com/content/early/2025/02/26/bjo-2024-326998