Short eyes need careful management after cataract surgery
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Key takeaways:
- Short eyes are at a higher risk for complications after cataract surgery.
- Prevention and careful management are key.
- Additional interventions should be performed only if necessary.
VILAMOURA, Portugal — Short eyes are at a higher risk for complications after cataract surgery and require careful management, according to a speaker at the European Society of Cataract and Refractive Surgeons winter meeting.
Quoting Wolfgang Haigis, the scientist known for his formulae, Ruth Lapid-Gortzak, MD, PhD, said that “the short eye is a very unforgiving eye,” at risk for IOP spikes, malignant and angle-closure glaucoma, corneal decompensation, residual refractive error and cystoid macular edema.
“Monitor IOP on the same day of surgery or on the morning after and supply patients with IOP-reducing medications in the first 24 hours,” she said. “Also, remember that in the long term these patients are still at risk for the creeping angle-closure glaucoma, so long-term follow-up is needed.”
If corneal decompensation occurs, she recommended conservative treatment with dexamethasone drops, sodium chloride 5% drops and IOP-lowering medications. If after 6 to 8 weeks there is no improvement, corneal transplantation may be necessary. Lamellar procedures are preferable but not easy in eyes with small anterior segments.
Unexpected refractive surprises occur in these eyes, and patients should be prepared for this event, according to Lapid-Gortzak.
In case of unilateral surprises, the best strategy is to aim for symmetry in refraction, and the treatment is more urgent if the other eye is already pseudophakic. In case of bilateral surprises, if symmetric, she recommended glasses or contact lenses, while asymmetric surprises need attention if binocular single vision is disturbed.
“Additional surgery should be performed only if conservative treatments are not an option,” Lapid-Gortzak said.
LASIK, PRK or SMILE can be performed within the limits of safe corneal laser surgery, and IOL exchange is better avoided in these eyes because there is little room for manipulation.
“Only do it if other means of correction are unacceptable,” she said.
Add-on lenses are risky because there is no standardization of pseudophakic sizing or power calculation and because there may not be sufficient space for an additional lens in shallow anterior chambers.
“Spectacles and contact lenses are safe, cheap, may even be a fashion statement, and there is nothing wrong with these options,” she said.
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Lapid-Gortzak R. Cataract surgery in short eyes: Postoperative management. Presented at: European Society of Cataract and Refractive Surgeons winter meeting; March 10-12, 2023; Vilamoura, Portugal.
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