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nanophthalmia [2026/07/27 11:14] – [References] Scott Larsonnanophthalmia [2026/07/27 12:08] (current) – Scott Larson
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 ===== Definition ===== ===== Definition =====
  
-Nanophthalmos is a rare developmental ocular disorder characterised by a small but structurally normal eye with a significantly shortened axial length (typically ≤20.5–21.0 mm; mean ~17.6–18.1 mm), high hyperopia (often +7 to +13 diopters), a high lens-to-eye volume ratio, shallow anterior chamber, thickened sclera, and small cornea. It represents the extreme end of the hyperopia spectrum and is distinct from microphthalmos, which involves structural ocular abnormalities.+  * Small but largely structurally normal eye 
 +  * Characterized by: 
 +    * Significantly shortened axial length (typically ≤20.5–21.0 mm; mean ~17.6–18.1 mm) 
 +    * [[high_hyperopia|High hyperopia]] (often +7 to +13 diopters),  
 +    * High lens-to-eye volume ratio 
 +    * Shallow anterior chamber 
 +    * Thickened sclera 
 +    * Small cornea.  
 +  * Distinct from [[microphthalmos|microphthalmos]], which involves structural ocular abnormalities.
  
 ===== Potential Causes / Genetics ===== ===== Potential Causes / Genetics =====
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   * Post-surgical complications — intraocular surgery carries an extremely high complication rate, including malignant glaucoma, suprachoroidal haemorrhage, choroidal effusion, and phthisis bulbi.   * Post-surgical complications — intraocular surgery carries an extremely high complication rate, including malignant glaucoma, suprachoroidal haemorrhage, choroidal effusion, and phthisis bulbi.
  
-===== Treatment =====+===== Surgical Consideration =====
  
-Treatment of nanophthalmos is challenging due to the high rate of surgical complications.+Treatment of glaucoma in the setting of nanophthalmos is challenging due to the high rate of surgical complications.
  
 == Medical Management == == Medical Management ==
- 
   * Glaucoma medications — effective for IOP control; however, miotics should be used with caution as they may worsen pupillary block.   * Glaucoma medications — effective for IOP control; however, miotics should be used with caution as they may worsen pupillary block.
   * Cycloplegic agents — may be used for refractive correction in children.   * Cycloplegic agents — may be used for refractive correction in children.
  
 == Laser Therapy == == Laser Therapy ==
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   * Laser peripheral iridotomy (LPI) — first-line for angle-closure; successful in ~83% of eyes.   * Laser peripheral iridotomy (LPI) — first-line for angle-closure; successful in ~83% of eyes.
   * Laser gonioplasty — successful in ~92% of eyes.   * Laser gonioplasty — successful in ~92% of eyes.
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 == Surgical Management == == Surgical Management ==
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   * Scleral decompression procedures (sclerectomy, sclerostomy, sclerotomy) — used for treatment and prophylaxis of uveal effusion syndrome. Concomitant sclerostomy during cataract surgery significantly reduces the occurrence of uveal effusion.   * Scleral decompression procedures (sclerectomy, sclerostomy, sclerotomy) — used for treatment and prophylaxis of uveal effusion syndrome. Concomitant sclerostomy during cataract surgery significantly reduces the occurrence of uveal effusion.
   * Cataract surgery — phacoemulsification has significantly fewer complications than manual small-incision cataract surgery (SICS). Lens extraction can also deepen the anterior chamber and help manage angle closure.   * Cataract surgery — phacoemulsification has significantly fewer complications than manual small-incision cataract surgery (SICS). Lens extraction can also deepen the anterior chamber and help manage angle closure.
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   * Vortex vein decompression — less frequently reported; used for uveal effusion.   * Vortex vein decompression — less frequently reported; used for uveal effusion.
   * Adjunctive treatments — mitomycin C and intravitreal anti-VEGF injections have been used as adjuncts to scleral decompression surgery.   * Adjunctive treatments — mitomycin C and intravitreal anti-VEGF injections have been used as adjuncts to scleral decompression surgery.
- 
 == Key Surgical Principles == == Key Surgical Principles ==
- 
   * Surgery in nanophthalmic eyes carries an extremely high complication rate; medication and laser therapy are the procedures of choice when feasible.   * Surgery in nanophthalmic eyes carries an extremely high complication rate; medication and laser therapy are the procedures of choice when feasible.
   * Prophylactic sclerostomy should be considered when intraocular surgery is planned.   * Prophylactic sclerostomy should be considered when intraocular surgery is planned.