Cataract surgery in Nanophthalmos

Nanophthalmic eyes are very small with a short axial length of less than 20 mm. This makes the cataract surgery far more challenging due to the limited working space. The anterior chamber is typically shallow and the cataractous crystalline lens seems very large in relation to the anterior segment dimensions. In this case, the pupil is also poorly dilating and the patient suffers from iris prolapse during the procedure. While this case would have been far easier if the nucleus was relatively soft, this patient opted to wait until the cataract became quite dense.

click below to learn how to perform cataract surgery in this tiny eye:

The video above is in real-time (11 minutes). If you are pressed for time, the video below is at 2x speed and has a different commentary:


  1. Dr Uday, using a cystitome for rhexis might probably prevent iris prolapse at the beginning of the case.

  2. Using a rhexis forcep that will fit through your sideport would minimize the iris prolapse. Bimanual phaco only opening bigger for the IOL would be beneficial also

  3. I have had reasonable results if a small amount(1 cc eg.)of vitreous was removed through the pars. This allows for further deepening of the AC with OVD, and giving more “breathing room.” Insert the vitrector only without an irrigating port and close sclerotomy with one horizontal mattress absorbable suture. Before closing, you may want to re-enter to remove more vit if AC not deep enough. Thanks

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