Cataract surgery in adult eyes with short axial length

Abstract

Purpose of reviewCataract surgery in eyes of patients with short axial length (AL) can be technically challenging and is associated with a high risk of intra- and postoperative complications. Several technical and surgical strategies have been proposed to optimize the visual outcome and decrease the rate of surgical complications and it is important to understand their applications in these casesRecent findingsTraditional intraocular lens (IOL) measurement formulas in eyes with short AL have reduced reliability. Novel formulas such as the Kane formula provide a better refractive prediction. Surgery can be difficult in short eyes due to the crowdedness of the anterior chamber (AC) and the associated scleral abnormalities increasing the risk of uveal effusion. Surgical techniques such as prophylactic scleral incisions, limited pars plana anterior vitrectomy, and modified hydrodissection, have been shown to facilitate surgery in extremely short eyes and decrease the rate of operative complications. Although cataract surgery improves vision in these cases, short AL and shallow AC have been associated with worse visual outcomes.SummaryNewer 4th generation IOL formulas have improved the refractive outcomes of cataract surgery in eyes with short AL. There are multiple evolving surgical strategies for optimizing surgery in these eyes. However, studies on the surgical and visual outcomes of cataract surgery in eyes with short AL are limited by their design and sample size. With further research and continued clinical experiences, we hope to develop evidence-based algorithms for the management of these complex cases.

Evolution of Biometric Formulas and Intraocular Lens Selection in Challenging Cases

“…Several technical and surgical strategies have been proposed to optimize the visual outcome and decrease the rate of surgical complications. It is essential to understand their applications in these cases [76]. To compare the accuracy of a new IOL power formula (Kane formula) with existing formulas using IOLMaster, predominantly model 3, biometry, and optimized lens constants, it found that the Kane formula was more accurate than existing formulas.…”

Long-Term Satisfaction of Oral Sedation versus Standard-of-Care Intravenous Sedation for Ocular Surgery

“…Cataract surgeries are primarily conducted with a topical anesthetic combined with a systemic sedative agent administered intravenously, 2 while general anesthesia is reserved for complex cases. 3 The use of oral sedation, as opposed to intravenous sedation, may be a cost- and space-saving measure facilitating the transition to office-based ocular procedures, but there remains a paucity of literature examining patient satisfaction with sedation in ocular procedures.…”