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Sharmila Rajendrababu, George V Puthuran, Naresh Babu, nanophthalmic eyes; Safety and Efficacy of Concomitant Prophylactic Sclerostomy with Cataract Surgery in Eyes with Nanonpthalmos. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2802.
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Cataract surgery in nanophthalmos is often associated with a high frequency of potentially blinding complications such as suprachoroidalhaemorrhage, uveal effusions and aqueous misdirections .
We conducted an unmasked randomized controlled trial of 60 eyes of 60 patients in eyes with nanophthalmos, visually significant cataract, and patent laser iridotomies. Eyes were randomly assigned to either cataract surgery alone or cataract surgery with concomitant prophylactic sclerostomy. The method for cataract removal was left to the discretion of the procedural surgeon after the randomization group was assigned. The frequency of having any intraoperative or postoperative complication likechoroidal effusion, aqueous misdirection,and retinal detachment was the primary study outcome, while secondary outcomes included visual acuity, IOP, and postoperative retino-choroidal thickness.
31 eyes were randomized to cataract surgery alone and 29 eyes were randomized to concurrent sclerostomy. In the entire study group, the mean age was 54.5 years, the mean axial length was 18.34 mm and, the mean lens thickness was 4.38 mm. Sixty percent of eyes underwent phacoemulsification, 35% underwent small incision cataract surgery and 5% underwent ECCE. Overall, sixteen of 60 eyes (52%) developed complications, including 12/31 (38.7%) eyes in the cataract alone group and 4/29(13.8%) in the cataract with concurrent sclerostomy group (p<.001). Four of 12 eyes (33%) in the cataract surgery only group developed postoperative choroidal effusions as compared to 0/29 eyes in the concurrent sclerostomy (p<.001)group. No significant group differences were observed with regards to change in visual acuity, IOP reduction, and in decrease of retino-choroidal thickness (p=0.54 ).
Surgery in Nanophthalmic eyes are often associated with disastrous complications like uvealeffusions ,expulsivehaemorhage, retinal detachment and angle closure or malignant glaucoma. Timely diagnosis and use of prophylactic measures preoperatively and prophylactic sclerostomy intraoperatively may minimize the risk of potential complications like uveal effusions in nanophthalmic eyes.
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