Cataract surgery in relative anterior microphthalmos

Area of Science:

• Ophthalmology
• Surgical Science

Background:

• Relative anterior microphthalmos (RAM) is a condition characterized by specific ocular dimensions: horizontal corneal diameter (HCD) ≤11 mm, anterior chamber depth (ACD) ≤2.2 mm, and axial length (AL) >20 mm.
• Understanding the prevalence and implications of RAM is crucial for optimizing cataract surgery outcomes.

Purpose of the Study:

• To determine the prevalence of relative anterior microphthalmos (RAM) in patients undergoing cataract surgery.
• To evaluate intraoperative performance and surgical outcomes in eyes diagnosed with RAM.

Main Methods:

• A nested case-control series involving 1400 consecutive patients undergoing cataract surgery.
• Preoperative measurements included HCD, ACD, and AL. RAM was defined by specific dimensional criteria.
• Comparison was made between RAM cases and two control groups (normal eyes and eyes with small corneal diameter).

Main Results:

• The prevalence of RAM was found to be 6% (84 of 1400 eyes).
• RAM was associated with intraoperative challenges, including reduced working space (70.24%), uveal trauma (14.28%), Descemet's detachment (5.95%), and posterior capsule rupture (2.38%).
• Postoperative complications included frequent transient corneal edema (75% on day 1).

Conclusions:

• Relative anterior microphthalmos (RAM) occurs in 6% of eyes undergoing cataract surgery.
• RAM is associated with significant intraoperative difficulties and a higher incidence of transient corneal edema postoperatively.
• Associated ocular conditions like small pupils, corneal guttae, glaucoma, and pseudoexfoliation are common in RAM patients.