SynthesisFrontiers in ophthalmology2026
Cataract and glaucoma surgery in microphthalmic, nanophthalmic, and high hyperopic eyes: a systematic review and meta-analysis.
Synthesis in Frontiers in ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Topic: This systematic review and meta-analysis evaluates 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. Clinical relevance: Nanophthalmos, microphthalmos, and high hyperopia are a spectrum of anatomic variants characterized by short axial length and crowded anterior segment. These features create significant risks for angle-closure glaucoma and complex cataract surgery. As existing literature is fragmented and limited to small case series, this study provides a comprehensive evaluation of surgical safety and efficacy in these high-risk populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a search was conducted across five databases (Cochrane, PubMed, Scopus, Ovid MEDLINE, and Embase via Ovid) for studies published between January 2010 and December 2024. Eligible studies reported original clinical data on surgical interventions for adult (≥ 18 years) patients with nanophthalmos, microphthalmos, or high hyperopia with concomitant cataract or glaucoma. Meta-analysis, subgroup analysis, and meta-regression were performed to assess changes in RE, VA, IOP, and ACD. Results: Meta-analysis of 21 articles involving 957 patients (1,110 eyes) suggests that surgical intervention is associated with improvement in clinical parameters across a spectrum of short eyes. Standalone phacoemulsification significantly reduced RE in nanophthalmic eyes (mean difference (MD) = -13.20 diopters (D); 95% confidence interval (CI): -15.19, -11.22; Q = 3.51, p = 0.48, I Conclusion: Surgical interventions in adults with nanophthalmos, microphthalmos, and high hyperopia were associated with meaningful improvements in RE, VA, IOP, and ACD, although outcomes varied by underlying diagnosis and procedure type. Standalone phacoemulsification consistently improved refractive and anatomical outcomes, particularly in nanophthalmos and high hyperopia, while combined procedures incorporating vitrectomy or filtering surgery achieved greater IOP reduction in eyes with concomitant glaucoma. Subgroup analyses suggested that shorter axial length and the presence of glaucoma influenced treatment response. However, substantial heterogeneity across studies and frequent post-operative complications highlight the need for standardized surgical protocols and higher-quality prospective studies to better define optimal management strategies for these anatomically complex eyes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033701, identifier CRD420251033701.
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