11 EyeWorld Asia Pacific | June 2024 Cataract Surgery in Short Eyes Short eyes are often the most challenging condition for cataract surgeons to manage. Preoperatively, lens selection can be tricky, as the effective lens position is hard to predict in these eyes. These patients are often hyperopic to begin with, and may be less accepting of a myopic result. Intraoperatively, issues with effusions and iris prolapse can make a routine case very complicated. Even after surgery, patients may need to be monitored for chronic angle closure from peripheral anterior synechiae or may need to be treated for aqueous misdirection should it occur. JoAnn Giaconi, MD, and Sahar Bedrood, MD, PhD, are both glaucoma specialists and cataract surgeons who have dealt with their fair share of short eyes. In this month’s YES Connect column, they review their approach to short eyes. They discuss their methods for lens selection and provide pearls of wisdom on how to avoid complications like iris prolapse and effusions. A prominent pearl to highlight: Do not underestimate how helpful relieving some posterior pressure at the start of cataract surgery can be. Placing a pars plana trocar and removing some vitreous will immediately deepen the anterior chamber, and the rest of the surgery will go routinely. – Mitra Nejad, MD, YES Connect Editor Performing cataract surgery in short eyes comes with certain challenges and considerations. Two surgeons discussed how to approach these patients, as well as certain formulas and surgical approaches that can help in these cases. Sahar Bedrood, MD, PhD, and JoAnn Giaconi, MD, defined a short eye as one that is less than 22 mm in axial length. “Less than 21 mm is where I personally will start making some adjustments to technique. For others it is less than 20 mm,” Dr. Giaconi said. by Ellen Stodola, Editorial Co-Director Dr. Bedrood said that patients with an axial length of less than 22 mm typically are hyperopic and may have narrow angles. “I perform intraocular pressure checks and gonioscopy to rule out angle closure, which would require IOP-lowering drops or more imminent cataract surgery for lens removal,” she said. “Accurate axial length measurements are key because we know that small deviations from the correct axial length in short eyes can lead to large refractive error. CATARACT
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