DIAGNOSTIC AND SURGICAL
TECHNIQUES
MARCO ZARBIN AND DAVID CHU, EDITORS
Cataract Surgery in the Small Adult Eye
Edward J. Wladis, MD, Matthew B. Gewirtz, MD, and Suqin Guo, MD
Institute of Ophthalmology and Visual Science, Department of Ophthalmology, UMDNJ-New Jersey Medical School,
Newark, New Jersey, USA
Abstract. Microphthalmos is a rare condition that is often associated with several other ocular
abnormalities. Given the considerable differences between microphthalmic and anatomically normal
eyes, cataract surgery is technically demanding in these patients, and special attention must be given to
adequate preoperative planning of these procedures. Furthermore, the unique nature of these
surgeries creates a particular subset of intraoperative and postoperative complications. However, with
the advent of piggyback intraocular lens placement, the visual outcomes of cataract surgery in small
adult eyes have improved considerably over the past 20 years. This review discusses the nature of the
microphthalmic eye, and addresses proper pre-, intra-, and postoperative care of the microphthalmic
patient. (Surv Ophthalmol 51:153--161, 2006. Ó 2006 Elsevier Inc. All rights reserved.)
Key words. cataract
interlenticular opacification
intraocular lens
microphthalmos
nanophthalmos
Introduction
DEFINITION OF MICROPHTHALMOS
Microphthalmos is a rare (0.046--0.11% of oph-
thalmology patients), complex condition with seri-
ous visual sequelae.
43
Simple microphthalmos is
a clinical state in which an eye is small but otherwise
anatomically intact. Conversely, pure microphthal-
mos (nanophthalmos) is marked by small (14--17
mm), hypermetropic (113 to 18 diopters) eyes with
microcornea.
3
These eyes also have large crystalline
lenses and a shallow anterior chamber.
51
The
thickened sclera in these eyes may block the vortex
veins, creating choroidal congestion, uveal effusion
(Figs. 1 and 2), and serous retinal detachment.
Alternatively, complex microphthalmos describes
a small eye with marked anatomic malformations,
including chorioretinal colobomas, persistent hy-
perplastic primary vitreous, and retinal dyspla-
sia.
2,4,10,15,33,54
Given this wide spectrum of
developmental abnormality and subsequent clinical
severity, cataract extraction remains a difficult chal-
lenge in these eyes and requires special consider-
ations; as such, we attempt to describe these
disorders and their associations and to discuss the
approaches necessary to perform surgery in patients
with these complications.
RELATION OF MICROPHTHALMOS TO OTHER
OCULAR DISORDERS
In light of the abnormal development of the
microphthalmic eye, several studies have shown
correlations between microphthalmos and other
153
Ó 2006 by Elsevier Inc.
All rights reserved.
0039-6257/06/$--see front matter
doi:10.1016/j.survophthal.2005.12.005
SURVEY OF OPHTHALMOLOGY
VOLUME 51
NUMBER 2
MARCH–APRIL 2006