Refractive Results and Complications of Lensectomy in Simple Extreme Microphthalmos Cases

To evaluate the refractive outcomes, changes in intraocular pressure (IOP) and anterior chamber depth (ACD), and postoperative complications following lensectomy for angle-closure in cases of simple extreme microphthalmos.

This retrospective study analyzed eyes with simple extreme microphthalmos (axial length <18 mm) that underwent lensectomy between January 2015 and July 2024. Data collection included demographic details, preoperative and postoperative best corrected visual acuity (BCVA), IOP, number of antiglaucoma medications, ACD, the diopter (D) of the implanted intraocular lens (IOL) according to the Hoffer-Q formula, postoperative refractive error, and surgical complications.

A total of 20 eyes from 12 patients were analyzed, with a mean patient age of 55.4±8.7 years and an average axial length of 16.48±0.8 mm. The average power of the implanted IOL was 53.32±6.2 D, ranging from 44 to 64 D. The mean preoperative spherical refractive equivalent (SE) was +12.4±2.8 D, while the mean postoperative SE was -6.67±5.2 D (p<0.05). Postoperative spherical refractive error exceeding -1.00 D was detected in 15 eyes (75%). Postoperatively, significant decreases were observed in IOP and the need for antiglaucoma medication (p=0.02 for both). The mean ACD increased significantly after surgery compared to the preoperative ACD (p=0.01). The difference between the intended refractive outcome and the postoperative spherical refractive error was statistically significant (p<0.05). Postoperatively, 8 eyes (40%) had a BCVA of ≤0.7 logarithm of the minimum angle of resolution (logMAR), 10 (50%) had a BCVA between >0.7 and <1.4 logMAR and 2 eyes (10%) had a BCVA of ≥1.4 logMAR.

Lensectomy in cases of extreme microphthalmos effectively reduces IOP and reliance on antiglaucoma medications and increases the ACD. However, a notable incidence of postoperative myopic refractive error remains a concern.