Managing Long or Short Axial Length in Cataract Surgery

Managing eyes at the extremes of axial length (AL)—longer than 26 mm or shorter than 20 mm—presents unique anatomical and surgical challenges during phacoemulsification. This article summarizes key considerations for biometry and intraocular lens (IOL) calculations, chamber stability, and the selection of minimally invasive glaucoma surgery (MIGS) procedures in these complex cases.

By
Lauren S. Blieden, MD
January 1, 2026
9 min

Glaucoma Physician

1

Managing cataract surgery in eyes with extreme axial lengths requires careful consideration of biometry and IOL calculations.
2

Short eyes risk aqueous misdirection and myopic surprises, necessitating specific preoperative and intraoperative strategies.
3

Long eyes may experience posterior pupillary block and require adjustments in IOL power calculations to ensure accuracy.
4

Minimally invasive glaucoma surgery can be performed during cataract surgery in longer eyes, but device placement must be carefully managed.
5

Maintaining a stable anterior chamber is crucial in both short and long eyes to prevent complications during cataract surgery.

Managing Long or Short Axial Length in Cataract Surgery

1

2

3

4

5

Original Source(s)

Managing Long or Short Axial Length in Cataract Surgery

Related Content

Rerouting Eye Care: How AI and Telemedicine Are Reshaping Ophthalmology Patient Journeys in the United Kingdom and Germany

Letter From the Editor: IOLs in Refractive Cataract Surgery

Integrating EyeCare