Treatment of Nanophthalmos-Related Uveal Effusion with Two- vs. Four-Quadrant Partial-Thickness Sclerectomy and Sclerotomy Surgery

Surgical Approaches to Serous Retinal Detachment With Retina-Lens Touch in Eyes With Nanophthalmos

Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina-lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.

Cataract surgery in adult eyes with short axial length

PURPOSE OF REVIEW

Cataract surgery in eyes of patients with short axial length (AL) can be technically challenging and is associated with a high risk of intra- and postoperative complications. Several technical and surgical strategies have been proposed to optimize the visual outcome and decrease the rate of surgical complications and it is important to understand their applications in these cases.

RECENT FINDINGS

Traditional intraocular lens (IOL) measurement formulas in eyes with short AL have reduced reliability. Novel formulas such as the Kane formula provide a better refractive prediction. Surgery can be difficult in short eyes due to the crowdedness of the anterior chamber (AC) and the associated scleral abnormalities increasing the risk of uveal effusion. Surgical techniques such as prophylactic scleral incisions, limited pars plana anterior vitrectomy, and modified hydrodissection, have been shown to facilitate surgery in extremely short eyes and decrease the rate of operative complications. Although cataract surgery improves vision in these cases, short AL and shallow AC have been associated with worse visual outcomes.

SUMMARY

Newer 4 th generation IOL formulas have improved the refractive outcomes of cataract surgery in eyes with short AL. There are multiple evolving surgical strategies for optimizing surgery in these eyes. However, studies on the surgical and visual outcomes of cataract surgery in eyes with short AL are limited by their design and sample size. With further research and continued clinical experiences, we hope to develop evidence-based algorithms for the management of these complex cases.