Cataract management in a patient with nanophthalmos

Purpose: To describe the clinical characteristics, the surgical management and the evolution after cataract surgery in a patient with nanophthalmos. Methods: We present the case of a 57‐year‐old woman with a progressive decrease in visual acuity referred for evaluation of a cataract intervention. As history, he presented high hyperopia [Right Eye (OD): +15.50; Left Eye (OS): +16.25], not corrected with glasses in childhood; episode of pupillary block 3 years ago treated with iridotomies in OD and chronic treatment with topical prostaglandin in both eyes. The best corrected visual acuity (BCVA) is 20/50 in both eyes. Slit‐lamp examination revealed very narrow anterior chambers, patent iridotomies, iridocrystalline synechiae, and advanced nuclear cataracts. Intraocular pressure is 21 mmHg in both eyes with latanoprost. Biometry reveals an axial length of 16.59 mm in OD and 16.60 mm in OS. A cataract was diagnosed in patient with bilateral nanophthalmos and it was decided to intervene in the OD. In surgery, 2 lamellar scleral incisions were made followed by suturing of the overlying conjunctiva and phacoemulsification with a 40D intraocular lens implant in the posterior chamber. Systemic corticosteroids were administered postoperatively. Results: Postoperative complications observed were: posterior synechiae and anterior capsule phimosis that required Nd‐YAG laser capsulotomy. Despite the good evolution, no improvement was obtained in visual acuity with respect to pre‐surgical values, and the patient currently has a BCVA of 20/50. Conclusions: Eyes with nanophthalmos require the recognition of cardinal signs of paramount importance for their diagnosis, as well as follow‐up and search for possible complications over time, and the use of extensive preoperative precautionary measures when surgical approach is necessary.