A Randomized Controlled Trial Comparing Outcomes of Cataract Surgery in Nanophthalmos With and Without Prophylactic Sclerostomy

Am J Ophthalmol. 2017 Nov;183:125-133. doi: 10.1016/j.ajo.2017.09.008. Epub 2017 Sep 11.


Purpose: To prospectively evaluate visual outcomes and complications during and after cataract surgery with or without prophylactic sclerostomy in nanophthalmic eyes with visually significant cataract.

Study design: Randomized controlled trial.

Methods: Sixty nanophthalmic eyes of 60 patients with visually significant cataract were randomly assigned to cataract surgery alone (control group, n = 31) or cataract surgery with concomitant prophylactic sclerostomy (sclerostomy group, n = 29). Surgery was performed using phacoemulsification or manual small-incision cataract surgery (SICS) based on the LOCS III grading score. Group differences in intraoperative and postoperative complications were analyzed and risk factors assessed.

Results: Fewer complications were noted in eyes receiving sclerostomy (5/29, 17.2%) as compared to control group eyes (12/31, 38.7%), though differences were marginally significant (P = .065). Four control group, but no sclerostomy group, eyes developed postoperative uveal effusions (P = .04). In multivariable models, sclerostomy decreased the odds of an intraoperative or postoperative complication by 80% (odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.04-0.92, P = .039); SICS was associated with a significantly higher risk of complications as compared to phacoemulsification (OR = 5.95, 95% CI = 1.49-23.73, P = .012), while high preoperative intraocular pressure (OR = 4.54, 95% CI = 0.99-20.9, P = .052) and greater lens thickness (OR = 3.38, 95% CI = 0.88-12.91, P = .075) demonstrated a marginally significant association.

Conclusions: Cataract surgery in eyes with nanophthalmos is associated with a high risk for vision-threatening complications. Performing a simultaneous prophylactic sclerostomy with cataract surgery reduces complication rates, particularly uveal effusions. Cataract surgery at earlier stages by phacoemulsification may be more beneficial than undergoing manual SICS.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Cataract / complications*
  • Female
  • Follow-Up Studies
  • Humans
  • Intraoperative Complications / prevention & control*
  • Male
  • Microphthalmos / complications*
  • Microphthalmos / surgery
  • Microsurgery / methods
  • Middle Aged
  • Phacoemulsification / adverse effects*
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Sclerostomy / methods*
  • Time Factors
  • Visual Acuity*