Outcomes of phacoemulsification and intraocular lens implantation in microphthalmos and nanophthalmos

To evaluate the outcomes of phacoemulsification and intraocular lens (IOL) implantation in microphthalmos and nanophthalmos.

Moorfields Eye Hospital, London, United Kingdom.

Retrospective case series.

Eyes with an axial length (AL) less than 21.0 mm had elective phacoemulsification and IOL implantation.

One hundred three eyes (63 patients) were enrolled. The median AL was 20.65 mm (interquartile range [IQR], 20.26 to 20.86) and the median follow-up, 6.3 months. Complications occurred in 16 cases (15.5%). Zonular dehiscence, severe uveitis, and aqueous misdirection accounted for the majority of complications. Complication rates were 6 (7.3%) of 82 cases with an AL from 20.0 to 21.00 mm and 10 (47.6%) of 21 cases with an AL less than 20.0 mm (P=.0001). Only AL (odds ratio [OR], 0.52 per mm; P≤.0005) and abnormal intraocular pressure (IOP) of 22 mm Hg or more or on topical IOP control (OR, 10.1; P=.001) were significant independent risk factors for complications. For the cohort after adjusting for abnormal IOP, an AL less than 20.5 mm was associated with a 4 times higher odds of any complication (P=.028), an AL less than 20.0 mm was associated with a 15 times higher odds of any complication (P≤.0005), and an AL less than 19.00 mm was associated with a 21 times higher odds of any complication (P≤.0005).

Phacoemulsification and IOL implantation in microphthalmos/nanophthalmos was challenging but appears safer than previously reported. A shorter AL and abnormal IOP were significant risk factors for complications.