Visual Rehabilitation After Complex Cataract Surgery in Bilateral Nanophthalmos with Extremely Short Axial Length

Abstract

The manifestation of nanophthalmos entails a significantly short axial length and a crowded anterior segment, which is extremely dangerous when performing cataract surgery. We describe visual and anatomical results of sequential cataract removal by phacoemulsification performed under topical anesthesia and intraocular lens implantation of high-power intraocular lenses in a patient with bilateral nanophthalmos (axial length of about 16 mm). Visual acuity preoperatively was 20/400 in the right eye and 20/200 in the left eye, with a hyperopic refractive error of more than +14.00 D. Deterioration of the axial length was found to be 16.2 mm (right eye) and 16.0 mm (left eye), and shallow anterior chamber depths were 2.1 mm and 2.0 mm, respectively. Similar results were obtained with the calculation of IOL power with Hoffer Q, Haigis, and Holladay 1 formula, which resulted in the implantation of high-power intraocular lenses (+47 diopter in the right eye and +48 diopter in the left eye; Medicontour). Surgical interventions were involving temporal procedure, poor dilation with iris hooks, trypan blue staining, controlled capsulorrhexis and cystotome use, and controlled intraoperative fluidics to reduce the effects of pressure fluctuations. The patient had left eye early postoperative choroidal effusion and extreme anterior segment inflammation with hypopyon, which improved with intensive topical corticosteroids and cycloplegic therapy. On the right eye, final corrected visual acuity improved to 20/30, and on the left eye, the visual acuity was 20/40. This case emphasizes the significance of careful preoperative evaluation, stability in the intraoperative chamber, and vigorous postoperative treatment in bringing positive visual restoration in extremely short eyes.