Cataract surgery in the extremely small eye: morphology, comorbidities and outcomes in 300 eyes
Reviewed by Jonathan Chan

This is a retrospective study from Heidelberg University, Germany, between January 2009 to October 2023, including 300 eyes of 191 patients undergoing cataract surgery with short axial length requiring lens implantation of > 30 dioptres. Eyes were classified into the following groups: moderate hyperopia (MH) (19.3%), high or low hyperopia (HH) (45.3%), nanophthalmos (N) (22.7%), and relative anterior microphthalmia (RAM) (12.7%). Co-morbidities included amblyopia (14.7%), previous squint surgery (7.3%), glaucoma (12.7%) and previous iridotomies (9.4%). Postoperative spherical equivalent was 0.42D (mean). There was no significant difference between preoperative corrected distance visual acuity (CDVA) and postoperative uncorrected visual acuity (mean 0.34 logMAR vs 0.47) respectively. Postoperative CDVA was better (mean 0.28 logMAR). The anterior chamber angle was significantly deepened, posterior capsule rupture rate was 3% and cystoid macular oedema was 5%. The authors concluded that the nanophthalmos subgroup showed a compromised outcome and this type of surgery assists spectacle independence with good patient satisfaction.

Cataract surgery in the extremely small eye: morphology, comorbidities and outcomes in 300 eyes.
Hammer M, Teich L, Friedrich M, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2025;109(8):917–24.