To evaluate refractive error (RE), visual acuity (VA), intraocular pressure (IOP), and anterior chamber depth (ACD) outcomes following surgical procedures in adults (≥ 18 years) with nanophthalmos, microphthalmos, and high hyperopia.
Approach:
Data Sources: Search conducted across five databases: Cochrane, PubMed, Scopus, Ovid MEDLINE, and Embase via Ovid for studies published between January 2010 and December 2024.
Key Findings:
Surgical intervention improved clinical parameters across a spectrum of short eyes.
Standalone phacoemulsification significantly reduced RE in nanophthalmic eyes (MD = -13.20 D; 95% CI: -15.19, -11.22) and high hyperopic eyes (MD = -9.23 D; 95% CI: -15.02, -3.45).
Standalone phacoemulsification improved VA in nanophthalmic eyes at both short-term (MD = -0.66 logMAR; 95% CI: -1.30, -0.02) and medium-term (MD = -0.70 logMAR; 95% CI: -1.30, -0.09) follow-up.
Phacoemulsification + filtering surgery resulted in significant worsening in VA at short-term follow-up for nanophthalmic eyes (MD = 0.28 logMAR; 95% CI: 0.21, 0.35).
Significant IOP reduction achieved primarily through combined procedures in both nanophthalmic and microphthalmic eyes.
Significant ACD deepening across all axial lengths (MD = 1.30 mm; 95% CI: 0.86, 1.74).
Interpretation:
Surgical interventions were associated with meaningful improvements in RE, VA, IOP, and ACD, although outcomes varied by diagnosis and procedure type.
Limitations:
Substantial heterogeneity across studies.
Frequent post-operative complications.
Limited power to detect the effect of race in meta-regression.
Conclusion:
Surgical outcomes in adults with nanophthalmos, microphthalmos, and high hyperopia showed improvements, but highlight the need for standardized surgical protocols and higher-quality prospective studies.
The key is execution, understanding the clinical landscape, controlling device cost, engineering the intraoperative workflow, and scheduling/staffing with intention.
