Nanophthalmic eyes are among the most challenging when it comes to cataract surgery. There are additional risks and the working space is very limited. The IOL calculations are also notoriously inaccurate and we often do not have an IOL with a high enough dioptric power. In the USA, the highest power IOL that I have found is +40.0 diopters in the Alcon AcrySof line, but in other countries even higher power IOLs are available. This patient received two IOLs primarily at the time of cataract surgery. This is similar to case that we previously featured here, but I would recommend caution with this technique. There may be a benefit to doing it staged with the highest power IOL you have going in the capsular bag and then waiting to see the resultant refractive outcome. Then a refractive vergence calculation can be done to determine the best piggyback IOL power to achieve emmetropia.
(Quiz question: Which nanophthalmic eye has a more challenging IOL calculation, one with a shallow AC or a deep AC? Answer is in the video)
