Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Complications of cataract surgery in short adult eyes of < 20.5 mm axial length

Eye volume 39, pages 1998–2002 (2025)Cite this article

Subjects

Abstract

Background

The complication rate of cataract surgery in eyes with a short axial length has previously been reported as being high, however previously published studies have had small participant numbers. The aim of the study was to determine the complication rate of cataract surgery in a large cohort of eyes of axial length <20.5 mm undertaken at a tertiary university hospital.

Methods

All adult eyes with axial length <20.5 mm having had cataract surgery between 2001 and 2020 at the Norfolk and Norwich University Hospital were identified retrospectively. The medical records of the patients meeting the study criteria were accessed to determine complication rates.

Results

Three hundred and sixty-eight consecutive eyes with axial length <20.5 mm were identified. Senior surgeons operated on 89% of eyes and fellows or residents (with at least 3 years of operating experience) operated on 11% of eyes. Intraoperative complications occurred in 4.3% of eyes and the majority of these complications were iris prolapse or iris trauma. Posterior capsule rupture occurred in 0.54% of eyes. There was a slightly higher complication rate for fellows and residents compared with senior surgeons, but this was not statistically significant (p = 0.4). Postoperative complications occurred in 8.2% of eyes.

Conclusions

Cataract surgery in small eyes can be undertaken safely and with comparatively low complication rates. Cataract surgery carried out by experienced surgeons and their ability to adapt surgical technique to the challenges of eyes with short axial length are fundamental factors to achieving low complication rates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from Medisoft Ophthalmology, Medisoft Limited, Leeds, UK, www.medisoft.co.uk, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Medisoft Ophthalmology, Medisoft Limited, Leeds, UK, www.medisoft.co.uk.

References

  1. Royal College of Ophthalmologists. National Ophthalmology Database Audit: Seventh Annual Report of the National Cataract Audit. National Cataract Audit for the 2022 NHS Year: 01 April 2022 to 31 March 2023. The Royal College of Ophthalmologists [Internet]. 2024;2024/NOD/473. Available from: https://nodaudit.org.uk/sites/default/files/2024-05/NOD Cataract Audit 7th Annual Report 2024_1.pdf

  2. Bro T, Behndig A, Viberg A, Zetterberg M, Kugelberg M, Nilsson I, et al. Two point four million cataract surgeries: 30 years with the Swedish National Cataract Register, 1992-2021. J Cataract Refract Surg. 2023;49:879–84.

    Article  PubMed  Google Scholar 

  3. Rajendrababu S, Babu N, Sinha S, Balakrishnan V, Vardhan A, Puthuran GV, et al. A randomized controlled trial comparing outcomes of cataract surgery in nanophthalmos with and without prophylactic sclerostomy. Am J Ophthalmol. 2017;183:125–33.

    Article  PubMed  Google Scholar 

  4. Carricondo PC, Andrade T, Prasov L, Ayres BM, Moroi SE. Nanophthalmos: a review of the clinical spectrum and genetics. J Ophthalmol. 2018;2018:2735465.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Singh OS, Simmons RJ, Brockhurst RJ, Trempe CL. Nanophthalmos: a perspective on identification and therapy. Ophthalmology. 1982;89:1006–12.

    Article  CAS  PubMed  Google Scholar 

  6. Altintaş AK, Acar MA, Yalvaç IS, Koçak I, Nurözler A, Duman S. Autosomal recessive nanophthalmos. Acta Ophthalmol Scand. 1997;75:325–8.

    Article  PubMed  Google Scholar 

  7. Jung KI, Yang JW, Lee YC, Kim SY. Cataract surgery in eyes with nanophthalmos and relative anterior microphthalmos. Am J Ophthalmol. 2012;153:1161–8.

    Article  PubMed  Google Scholar 

  8. Yalvac IS, Satana B, Ozkan G, Eksioglu U, Duman S. Management of glaucoma in patients with nanophthalmos. Eye. 2008;22:838–43.

    Article  CAS  PubMed  Google Scholar 

  9. Wladis EJ, Gewirtz MB, Guo S. Cataract surgery in the small adult eye. Surv Ophthalmol. 2006;51:153–61.

    Article  PubMed  Google Scholar 

  10. Carifi G, Safa F, Aiello F, Baumann C, Maurino V. Cataract surgery in small adult eyes. Br J Ophthalmol. 2014;98:1261–5.

    Article  PubMed  Google Scholar 

  11. Day AC, MacLaren RE, Bunce C, Stevens JD, Foster PJ. Outcomes of phacoemulsification and intraocular lens implantation in microphthalmos and nanophthalmos. J Cataract Refract Surg. 2013;39:87–96.

    Article  PubMed  Google Scholar 

  12. Lemos JA, Rodrigues P, Resende RA, Menezes C, Gonçalves RS, Coelho P. Cataract surgery in patients with nanophthalmos: results and complications. Eur J Ophthalmol. 2016;26:103–6.

    Article  PubMed  Google Scholar 

  13. Yuzbasioglu E, Artunay O, Agachan A, Bilen H. Phacoemulsification in patients with nanophthalmos. Can J Ophthalmol. 2009;44:534–9.

    Article  PubMed  Google Scholar 

  14. Yosar JC, Zagora SL, Grigg JR. Cataract surgery in short eyes, including nanophthalmos: visual outcomes, complications and refractive results. Clin Ophthalmol. 2021;15:4543–51.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Steijns D, Bijlsma WR, Van der Lelij A. Cataract surgery in patients with nanophthalmos. Ophthalmology. 2013;120:266–70.

    Article  PubMed  Google Scholar 

  16. Singh H, Wang JC, Desjardins DC, Baig K, Gagné S, Ahmed II. Refractive outcomes in nanophthalmic eyes after phacoemulsification and implantation of a high-refractive-power foldable intraocular lens. J Cataract Refract Surg. 2015;41:2394–402.

    Article  PubMed  Google Scholar 

  17. Zheng T, Chen Z, Xu J, Tang Y, Fan Q, Lu Y. Outcomes and prognostic factors of cataract surgery in adult extreme microphthalmos with axial length <18 mm or corneal diameter <8 mm. Am J Ophthalmol. 2017;184:84–96.

    Article  PubMed  Google Scholar 

  18. Day AC, Khawaja AP, Peto T, Hayat S, Luben R, Broadway DC, et al. The small eye phenotype in the EPIC-Norfolk eye study: prevalence and visual impairment in microphthalmos and nanophthalmos. BMJ Open. 2013;3:e003280.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sihota R, Lakshmaiah NC, Agarwal HC, Pandey RM, Titiyal JS. Ocular parameters in the subgroups of angle closure glaucoma. Clin Exp Ophthalmol. 2000;28:253–8.

    Article  CAS  PubMed  Google Scholar 

  20. Shalaby WS, Reddy R, Razeghinejad R, Katz LJ. Contemporary approach to narrow angles. J Ophthalmic Vis Res. 2024;19:88–108.

    PubMed Central  Google Scholar 

  21. Shahid H, Salmon JF. Malignant glaucoma: a review of the modern literature. J Ophthalmol. 2012;2012:852659.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kim YK, Yoo BW, Kim HC, Aung T, Park KH. Relative lens vault in subjects with angle closure. BMC Ophthalmol. 2014;14:93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge and thank Medisoft Ophthalmology, Medisoft Limited, Leeds, UK, www.medisoft.co.uk, for their assistance with data collection.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK

    Nuwan Niyadurupola, David C. Broadway & Tom Eke

Authors
  1. Nuwan Niyadurupola
    View author publications

    Search author on:PubMed Google Scholar

  2. David C. Broadway
    View author publications

    Search author on:PubMed Google Scholar

  3. Tom Eke
    View author publications

    Search author on:PubMed Google Scholar

Contributions

All authors were responsible for the conceptualisation and design of the study. NN was responsible for data collection, data analysis, interpretation and manuscript preparation. All authors contributed to manuscript preparation, proof reading the manuscript and responses to the reviewers’ comments.

Corresponding author

Correspondence to Nuwan Niyadurupola.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niyadurupola, N., Broadway, D.C. & Eke, T. Complications of cataract surgery in short adult eyes of < 20.5 mm axial length. Eye 39, 1998–2002 (2025). https://doi.org/10.1038/s41433-025-03799-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-025-03799-x

Search

Advanced search

Quick links