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Complications of cataract surgery on small eyes and nanophthalmosM. Ledergerber, D. T. Pham
Background: It has been reported in literature that cataract and glaucoma surgery on small eyes and nanopthalmos are often accompanied by severe intra- and postoperative complications such as cornea decompensation, iris lesion, capsular rupture, angle closure glaucoma or uveal effusion, all of which are conditioned by an excessive vis-à-tergo. It was the aim of this study to obtain more information on the possibilities to reduce the incidence of these complications by increasing the anterior chamber depth with additional osmotic dehydratation of the vitreous body and extensive oculopression.
Patients and Methods: In a retrospective study we analysed 73 eyes with an axiallength of 18.86 to 20.99 mm after cataract surgery. Preoperatively each patient recieved 250 ml Osmofundin intravenously and a 30-minute oculopression at 40 mmHg. PMMA posterior chamber lenses of 28.5-35.0 D were implanted. 67 operations were performed in sponge and intracameral anaesthesia, 6 patients recieved a retrobulbar injektion. The most frequent preoperative finding was in 37% (27/73) of cases a glaucoma including pseudoexfoliation syndrome. 17 eyes (23.3%) had undergone glaucoma surgery previously.
Results: Intraoperatively, moderate vis-à-tergo ocurred in 8.2% (6173). Other complications were absent. None of the operations had to be interrupted because of vis-à-tergo. Postoperative complications were limited to increasing IOP up to 59 mmHg and pupil deviation in 9 eyes (12.3%) altogether. One patient had undergone a second operation because of incomplete cortex extraction. Visual acuity improved from 0.3 to 0.48 after surgery.
Conclusion: A comparision of our results with those of other studies laid down in the literature shows, that the intra- and postoperative complications of cataract surgery on small eyes and nanophthalmos can be further reduced by the combination of preoperative Osmofundin and extensive oculopression.
Augenklinik, Krankenhaus Neukölln, Rudower Str. 48, D- 12313 Berlin