Surgical intervention improves refractive error and visual acuity in short eyesSurgery Improves Vision Outcomes for Patients with Short Eyes
Frontiers in MedicinePublished July 24, 2026Study authors: Rebecca Zheng Li, Abdullah Virk, David Bulanov, Justin Zhang, Eugene Wang, Henry Qin, Trang Bui, Kar…DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
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Key Takeaway
Consider surgical intervention to improve visual acuity and refractive error in patients with nanophthalmos and high hyperopia.
This systematic review and meta-analysis evaluates surgical interventions for patients with short eyes, including nanophthalmos, microphthalmos, and high hyperopia. The analysis included 957 patients (1,110 eyes) to assess refractive error (RE), visual acuity (VA), intraocular pressure (IOP), and anterior chamber depth (ACD).
Key findings indicate that standalone phacoemulsification led to a significant reduction in RE for nanophthalmic eyes (-13.20 D; 95% CI: -15.19, -11.22) and high hyperopic eyes (-9.23 D; 95% CI: -15.02, -3.45). Visual acuity improved in nanophthalmic eyes with standalone phacoemulsification at both short-term (-0.66 logMAR) and medium-term (-0.70 logMAR) follow-ups. Additionally, a significant increase in anterior chamber depth of 1.30 mm (95% CI: 0.86, 1.74) was observed across all axial lengths.
While standalone phacoemulsification improved refractive and anatomical outcomes, combined procedures were more effective for reducing IOP in nanophthalmic and microphthalmic eyes, particularly when glaucoma was present. The authors note significant limitations including high heterogeneity in results for RE, VA, and ACD. Furthermore, the study had limited power to detect the effect of race on outcomes.
How this fits prior evidence
This meta-analysis addresses a gap in surgical management for complex ocular conditions like nanophthalmos and microphthalmos. While previous evidence highlights medical and procedural options for glaucoma, such as brinzolamide/timolol for IOP reduction or various cyclophotocoagulation techniques, this study specifically evaluates the impact of phacoemulsification on refractive outcomes and anatomical parameters in short-eye populations.
Researchers analyzed data from 957 patients to see how surgery affects people with short eyes, including those with nanophthalmos, microphthalmos, and high hyperopia. The study looked at several factors, such as vision clarity, eye pressure, and the physical depth of the front part of the eye.
The results showed that standalone phacoemulsification helped reduce refractive errors and improve visual acuity in patients with nanophthalmic eyes. For those with high hyperopia, the surgery also significantly reduced refractive errors. Additionally, all patients saw an increase in anterior chamber depth regardless of their specific eye measurements.
While standalone surgery improved vision, combined procedures were found to be more effective at lowering internal eye pressure for patients with glaucoma. Because this was a meta-analysis of existing data and showed high variation in some results, these findings are not a guarantee for every individual. Patients should talk to their doctors to see how these surgical outcomes apply to their specific needs.
What this means for you:
Surgery can improve vision and eye measurements for people with short eyes, but results vary by specific condition.
Common questions
How does surgery help people with nanophthalmic eyes?
Standalone phacoemulsification was shown to significantly reduce refractive error by 13.20 diopters at medium-term follow-up. It also led to significant improvements in visual acuity during both short-term and medium-term follow-up periods for these patients.
What are the benefits of combined procedures for glaucoma?
For patients with nanophthalmic or microphthalmic eyes who also have glaucoma, combined procedures were found to be more effective at significantly reducing intraocular pressure compared to standalone procedures.
Does surgery improve the physical structure of the eye?
Yes, the study found that a significant deepening of the anterior chamber depth was achieved across all axial lengths. This measurement increased by 1.30 mm for patients undergoing these surgical procedures.
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.
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.
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.
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, I2 = 0.0%) at medium-term follow-up and in high hyperopic eyes (MD = -9.23 D; 95% CI: -15.02, -3.45; Q = 322.19, p < 0.001, I2 = 97.8%) at medium-term follow-up with high heterogeneity in the effects. Standalone phacoemulsification significantly improved VA in nanophthalmic eyes at both short-term (MD = -0.66 logarithm of the minimum angle of resolution (logMAR); 95% CI: -1.30, -0.02; Q = 98.45, p < 0.001, I2 = 97.0%) and medium-term (MD = -0.70 logMAR; 95% CI: -1.30, -0.09; Q = 97.14, p < 0.001, I2 = 93.8%) follow-up with high heterogeneity in the effects. In contrast, phacoemulsification + filtering surgery resulted in a significant worsening in VA at short-term follow-up for nanophthalmic eyes (MD = 0.28 logMAR; 95% CI: 0.21, 0.35; Q = 1.24, p = 0.27, I2 = 19.4%). Significant IOP reduction was achieved primarily through combined procedures in both nanophthalmic and microphthalmic eyes. Presence of concomitant glaucoma was associated with a greater reduction in IOP across all axial lengths. Significant ACD deepening was achieved across all axial lengths (MD = 1.30 millimeters (mm), 95% CI: 0.86, 1.74; Q = 244.55, p < 0.001, I2 = 99.3%) with high heterogeneity in the effects. Meta-regression identified a significant study-level association between mean age and post-operative RE (multiple adjusted coefficient: 10.72, p = 0.001). No effect of race was detectable in this study-level meta-regression, although power was limited.
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.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033701, identifier CRD420251033701.
