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Cataract surgery in tiny eyes
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Microphthalmic eyes are a challenge because of the smaller anatomy, tighter working space and limited IOL selection.
 Postop cataract patient with microphthalmos. The corneal diameter is 8 mm, and the lens implant is an AcrySof. |
This patient has a corneal diameter of just 8 mm and an axial length of less than 20 mm. For cataract surgery, there is very little working space, and the capsular bag is smaller than usual. In these tiny eyes, IOL calculations are more difficult and more sensitive to any variances in effective lens position. The Holladay 2 formula takes into account many factors to come up with a more accurate estimation of effective lens position and therefore tends to be more precise in predicting IOL power.
The selection of IOLs for these small eyes is limited, but fortunately there are lenses such as the Alcon AcrySof series, which are available in high powers up to +40 D so that we can avoid using piggyback IOLs. In addition, the single-piece hydrophobic acrylic IOLs are soft and compliant and are able to conform to the smaller capsular bag.
Phacoemulsification should be performed in the capsular bag to avoid corneal endothelial trauma in eyes with shallow and small anterior chambers. The smaller incisions of micro-coaxial phaco are also helpful to minimize astigmatic effect.
Microphthalmic eyes are rare, occurring in less than 1% of the population, but when it's time to do cataract surgery in these tiny eyes, I am thankful to have the appropriate tools and products to achieve an excellent outcome.
See Dr. Devgan share more expert insight live at OSN New York 2010, to be held November 19-21, 2010 at the Sheraton New York Hotel & Towers. Learn more at OSNNY.com.