To describe the demographic features of a large series of patients with floppy eyelid syndrome (F... more To describe the demographic features of a large series of patients with floppy eyelid syndrome (FES) and to investigate the associations of the condition with keratoconus, obstructive sleep apnea-hypopnea syndrome (OSAHS), and a variety of upper and lower eyelid features. Case control study. The test group comprised 102 patients with FES. A control group of 102 patients were recruited from a diabetic retinopathy clinic and matched on a 1:1 basis on age, gender, and body mass index (BMI). A full medical and ophthalmic history was taken. Patients also underwent a full ocular examination, including an assessment of upper and lower lid laxity and upper lid levator function. Keratoconus grading was made using the Oculus Instruments Pentacam imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany). Patients were screened for OSAHS using the Epworth daytime somnolence score. Matched statistical analysis of dichotomous data was made using Mantel-Haenszel methods for odds ratios and McNemar's test. Analysis of continuous data was performed using a matched t test and tests for symmetry of larger tables were made using the McNemar-Bowker test. The significance of association of FES with keratoconus, OSAHS, smoking history, medial and lateral canthal laxity of the upper and lower lids, levator function, lash ptosis, and dermatochalasis. Significant associations were found between FES and OSAHS (P = 0.0008), keratoconus (P<0.0001), lash ptosis (P<0.0001), dermatochalasis (P = 0.02), upper lid medial canthal laxity (P = 0.02), upper lid distraction (P = 0.001), palpebral aperture (P = 0.004), and levator function (P = 0.005). Floppy eyelid syndrome seems to be a condition strongly associated with OSAHS and keratoconus. As well as providing a platform for an etiologic hypothesis for the condition, these findings should also encourage clinicians to be aware of these associations and to direct further treatment. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is desi... more This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is designed to be a simple guide to ophthalmic researchers on a statistical issue with an applied ophthalmic example. The OSG is a collaborative group of statisticians who have come together with a desire to raise the statistical standards of ophthalmic researcher by increasing statistical awareness of common issues.
ABSTRACT Purpose: The aim of this study was to assess interobserver variability when grading prog... more ABSTRACT Purpose: The aim of this study was to assess interobserver variability when grading progression of Age Related Macular Degeneration (AMD) using the International Classification (IC) system and to assess agreement with clinical decision.Methods: Fifty eyes with a minimum of 5 years disease duration documented by colour photographs were selected from the London AMD Study. Changes related to early and late AMD were graded in a random fashion while masked to the main purpose of the study (FS) and then independently by another grader (IL). Images in time-sequence were independently analysed for clinical changes. Digitized time-sequential fundus images were then aligned in uniform fashion, arranged into multi-layered composites using Adobe Photoshop and clinical assessment made (TP, ACB). Results were compared and a consensus decision was made.Results: Inter-observer agreement was 89.4% for predominant phenotype (κ=0.84), 89.36%-91.49% for CNV (κ=0.79-0.83), 87.23%-89.36% for GA (κ=0.62-0.74) and 55.32% for area covered by drusen (κ=0.31). In 4 cases the clinical and IC classifications differed: drusen area in 2 and two of end-stage disease grading; resulting in 97.8% concordance in identification of change. At baseline,34 eyes had soft drusen, 15 had CNV and one had GA. Of the 34 with Drusen, 14 developed CNV and 9 GA by the end of the study. Disappearance of drusen without end-stage disease was recorded in two eyes.Conclusions: Overall, changes observed clinically were reflected accurately by the IC grading in the majority of cases. This provides a quantitative basis for using this classification system in longitudinal studies. The accidental observation of regressing drusen without end-stage disease merits further investigation.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
Macular degeneration is known to be a bilateral disease. This study set out to determine the symm... more Macular degeneration is known to be a bilateral disease. This study set out to determine the symmetry of phenotype between eyes of patients with bilateral early AMD (or drusen) or late-stage AMD. This may be important information when considering the likelihood of anti-VEGF treatment. This prospective, observational, cross-sectional study graded the color fundus photographs of both eyes of 1,114 Caucasian patients with either early or late-stage AMD. Patients were recruited from a tertiary referral UK population. The main outcomes were phenotype, comparison of number, type and overall area of drusen in early AMD and symmetry of late AMD. The overall agreement of phenotype in the entire cohort of patients was 53%, kappa statistic (κ)=0.31, (95% CI = 0.27-0.36). Within this group, a total of 271 patients were identified with bilateral soft and hard drusen (early AMD). Symmetry of phenotype within this group was high in terms of total of area of drusen (agreement = 79%, weighted κ = 0.75) and number of drusen. In those with bilateral geographic atrophy (GA), symmetry between area of GA was moderate (agreement 72%, weighted κ = 0.54), and in those with bilateral neovascular disease (choroidal neovascularization or pigment epithelial detachment), symmetry was poor (agreement 45%, weighted κ = 0.16). Out of the entire cohort, 62% (n = 688) had neovascular disease in at least one eye and 37.5% of these had bilateral disease. The observed symmetry of phenotype between eyes with drusen appears to reduce in GA and neovascular forms of AMD. Overall, 53% of the cohort had symmetrical disease in terms of phenotype, 23% had neovascular disease in both eyes, 9.3% had GA in both eyes, and 39% of patients had neovascular disease in one eye and non-neovascular disease in the other. This may have implications for the potential need for anti-VEGF treatment of AMD in second eye involvement.
To determine whether grading based on the International Classification (IC) for age-related macul... more To determine whether grading based on the International Classification (IC) for age-related macular degeneration (AMD) allows recognition of change during the progression of the disease. Stereoscopic color fundus photographs of 50 eyes of 25 patients with AMD and at least 5 years of review were graded in a random and masked fashion for changes over time in the characteristics of drusen, pigmentary changes, and end-stage disease, according to the system defined by the IC for AMD, by two independent graders (F.B.S., I.L.). Fundus images were also analyzed in time sequence for clinical changes by a senior grader (I.L.) and two ophthalmologists (A.C.B., T.P.) without access to the grading forms of the IC grading. Clinical change, as recorded by the IC grading and the individual analysis, were compared. There was 97.8% (kappa = 0.70) concordance in identification of change. In four cases, the clinical classification differed from the IC grading: Two cases of drusen and two of end-stage disease grading. Inter-observer agreement for the IC grading was 89.4% for predominant phenotype (kappa = 0.84), 89.36-91.49% for presence of choroidal neovascularization (CNV) (kappa = 0.79-0.83), 87.23-89.36% for geographic atrophy (GA) (kappa = 0.62-0.74) and 55.32% for area covered by drusen (kappa = 0.31). Overall, progression from earlier stages of AMD to either of the two forms of advanced AMD were reflected accurately by the IC grading in the vast majority of cases.
AIMTo determine whether pharmacological mydriasis leads to a significant difference in interobser... more AIMTo determine whether pharmacological mydriasis leads to a significant difference in interobserver agreement of optic disc measurement compared with examination without mydriasis.METHODA cross sectional study was performed with a pair of observers examining the optic disc of two randomised groups of patients, one group before diagnostic mydriasis, and the other afterwards. Horizontal and vertical disc diameters and cup/disc ratios were
To study the characteristics of second treated eyes in patients with neovascular age-related macu... more To study the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the United Kingdom National Health Service. Multicenter national nAMD database study. Twelve thousand nine hundred fifty-one treatment-naïve eyes of 11,135 patients receiving 92,976 ranibizumab injections. Up to 5 years of routinely collected, anonymized data within electronic medical record systems were extracted remotely from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (loading phase of 3 monthly injections followed by monthly visits and pro re nata re-treatment). The minimum data set included: age, logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) at baseline and at all subsequent visits, and injection episodes. Baseline, change and actual VA over 3 years, and number of treatments and clinic visits. During the study, 1816 (16.3%) of the 11 135 patients received treatment to the fellow eye. Mean baseline and final VA were 0.66 (standard deviation, 0.32) and 0.65 (0.40) for first treated eyes and 0.41 (0.34) and 0.56 (0.40) for second treated eyes. The rate of VA loss after the loading phase was similar in first and second treated eyes (0.03 and 0.05 logMAR units/year). When fellow eyes with baseline VA worse than 20/200 were excluded to restrict analyses to eyes at risk of nAMD, the rate of second-eye involvement was 14.0% per year (42%/3 years). Mean number of injections/visits in years 1, 2, and 3 were similar for first and second treated eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4, and 3.8/9.1, respectively). Second treated eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better VA than first treated eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes which theoretically may reduce the benefits of extended monitoring regimens.
To identify and describe the different procedures used in the treatment of floppy eyelid syndrome... more To identify and describe the different procedures used in the treatment of floppy eyelid syndrome (FES) at Moorfields Eye Hospital and to evaluate their effectiveness.Cross-sectional study.A total of 71 patients who had undergone surgery for FES over a 13-year period since 1995 at Moorfields Eye Hospital were recruited. Retrospective data from 7 patients were also included, providing data for 78 patients.Patients underwent a full ocular examination. A survival analysis was determined by plotting Kaplan–Meier curves for each type of procedure encountered. Comparison of survival trends was made using a log-rank test. The possible effects of bias arising from bilaterality of the condition were investigated using a sensitivity analysis and a Cox regression analysis allowing for clusters. Tests for surgeon bias were made using the Fisher exact test.Recurrence of the condition. An assessment of recurrence was made clinically by 2 independent observers who were masked to the type of surgery the patient had undergone.Four different forms of surgical treatment were encountered: (1) Full-thickness wedge excision (FTWE) (26 patients, 33 procedures); (2) Upper lid lateral tarsal strip (LTS) (31 patients, 43 procedures); (3) Medial canthal (MC) and lateral canthal (LC) plication (15 patients, 19 procedures); (4) Medial tarsal strip (6 patients, 6 procedures). A total of 44 of 101 procedures had failed. Superior long-term survival outcomes of both LC/MC plication (P = 0.003) and upper lid LTS (P = 0.001) procedures over FTWE was demonstrated. However, survival comparison between the LC/MC plication and LTS groups did not achieve significance (P = 0.37). No significant difference in outcome between surgeon groups of equivalent experience was demonstrated (P = 0.18). No bias arising from bilaterality of the condition was identified.These data provide strong evidence of better survival outcomes in FES using the MC/LC plication and LTS procedures in comparison with the FTWE procedure. On the basis of experience from our unit, we recommend that the FTWE procedure be avoided as a form of treatment for FES in favor of the MC/LC plication, LTS, or medial tarsal strip procedure.The author(s) have no proprietary or commercial interest in any materials discussed in this article.
To evaluate the outcomes of phacoemulsification and intraocular lens (IOL) implantation in microp... more To evaluate the outcomes of phacoemulsification and intraocular lens (IOL) implantation in microphthalmos and nanophthalmos. Moorfields Eye Hospital, London, United Kingdom. Retrospective case series. Eyes with an axial length (AL) less than 21.0 mm had elective phacoemulsification and IOL implantation. One hundred three eyes (63 patients) were enrolled. The median AL was 20.65 mm (interquartile range [IQR], 20.26 to 20.86) and the median follow-up, 6.3 months. Complications occurred in 16 cases (15.5%). Zonular dehiscence, severe uveitis, and aqueous misdirection accounted for the majority of complications. Complication rates were 6 (7.3%) of 82 cases with an AL from 20.0 to 21.00 mm and 10 (47.6%) of 21 cases with an AL less than 20.0 mm (P=.0001). Only AL (odds ratio [OR], 0.52 per mm; P≤.0005) and abnormal intraocular pressure (IOP) of 22 mm Hg or more or on topical IOP control (OR, 10.1; P=.001) were significant independent risk factors for complications. For the cohort after adjusting for abnormal IOP, an AL less than 20.5 mm was associated with a 4 times higher odds of any complication (P=.028), an AL less than 20.0 mm was associated with a 15 times higher odds of any complication (P≤.0005), and an AL less than 19.00 mm was associated with a 21 times higher odds of any complication (P≤.0005). Phacoemulsification and IOL implantation in microphthalmos/nanophthalmos was challenging but appears safer than previously reported. A shorter AL and abnormal IOP were significant risk factors for complications.
To describe the demographic features of a large series of patients with floppy eyelid syndrome (F... more To describe the demographic features of a large series of patients with floppy eyelid syndrome (FES) and to investigate the associations of the condition with keratoconus, obstructive sleep apnea-hypopnea syndrome (OSAHS), and a variety of upper and lower eyelid features. Case control study. The test group comprised 102 patients with FES. A control group of 102 patients were recruited from a diabetic retinopathy clinic and matched on a 1:1 basis on age, gender, and body mass index (BMI). A full medical and ophthalmic history was taken. Patients also underwent a full ocular examination, including an assessment of upper and lower lid laxity and upper lid levator function. Keratoconus grading was made using the Oculus Instruments Pentacam imaging system (Oculus Optikgerate GmbH, Wetzlar, Germany). Patients were screened for OSAHS using the Epworth daytime somnolence score. Matched statistical analysis of dichotomous data was made using Mantel-Haenszel methods for odds ratios and McNemar's test. Analysis of continuous data was performed using a matched t test and tests for symmetry of larger tables were made using the McNemar-Bowker test. The significance of association of FES with keratoconus, OSAHS, smoking history, medial and lateral canthal laxity of the upper and lower lids, levator function, lash ptosis, and dermatochalasis. Significant associations were found between FES and OSAHS (P = 0.0008), keratoconus (P<0.0001), lash ptosis (P<0.0001), dermatochalasis (P = 0.02), upper lid medial canthal laxity (P = 0.02), upper lid distraction (P = 0.001), palpebral aperture (P = 0.004), and levator function (P = 0.005). Floppy eyelid syndrome seems to be a condition strongly associated with OSAHS and keratoconus. As well as providing a platform for an etiologic hypothesis for the condition, these findings should also encourage clinicians to be aware of these associations and to direct further treatment. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is desi... more This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is designed to be a simple guide to ophthalmic researchers on a statistical issue with an applied ophthalmic example. The OSG is a collaborative group of statisticians who have come together with a desire to raise the statistical standards of ophthalmic researcher by increasing statistical awareness of common issues.
ABSTRACT Purpose: The aim of this study was to assess interobserver variability when grading prog... more ABSTRACT Purpose: The aim of this study was to assess interobserver variability when grading progression of Age Related Macular Degeneration (AMD) using the International Classification (IC) system and to assess agreement with clinical decision.Methods: Fifty eyes with a minimum of 5 years disease duration documented by colour photographs were selected from the London AMD Study. Changes related to early and late AMD were graded in a random fashion while masked to the main purpose of the study (FS) and then independently by another grader (IL). Images in time-sequence were independently analysed for clinical changes. Digitized time-sequential fundus images were then aligned in uniform fashion, arranged into multi-layered composites using Adobe Photoshop and clinical assessment made (TP, ACB). Results were compared and a consensus decision was made.Results: Inter-observer agreement was 89.4% for predominant phenotype (κ=0.84), 89.36%-91.49% for CNV (κ=0.79-0.83), 87.23%-89.36% for GA (κ=0.62-0.74) and 55.32% for area covered by drusen (κ=0.31). In 4 cases the clinical and IC classifications differed: drusen area in 2 and two of end-stage disease grading; resulting in 97.8% concordance in identification of change. At baseline,34 eyes had soft drusen, 15 had CNV and one had GA. Of the 34 with Drusen, 14 developed CNV and 9 GA by the end of the study. Disappearance of drusen without end-stage disease was recorded in two eyes.Conclusions: Overall, changes observed clinically were reflected accurately by the IC grading in the majority of cases. This provides a quantitative basis for using this classification system in longitudinal studies. The accidental observation of regressing drusen without end-stage disease merits further investigation.
Graefe's Archive for Clinical and Experimental Ophthalmology, 2011
Macular degeneration is known to be a bilateral disease. This study set out to determine the symm... more Macular degeneration is known to be a bilateral disease. This study set out to determine the symmetry of phenotype between eyes of patients with bilateral early AMD (or drusen) or late-stage AMD. This may be important information when considering the likelihood of anti-VEGF treatment. This prospective, observational, cross-sectional study graded the color fundus photographs of both eyes of 1,114 Caucasian patients with either early or late-stage AMD. Patients were recruited from a tertiary referral UK population. The main outcomes were phenotype, comparison of number, type and overall area of drusen in early AMD and symmetry of late AMD. The overall agreement of phenotype in the entire cohort of patients was 53%, kappa statistic (κ)=0.31, (95% CI = 0.27-0.36). Within this group, a total of 271 patients were identified with bilateral soft and hard drusen (early AMD). Symmetry of phenotype within this group was high in terms of total of area of drusen (agreement = 79%, weighted κ = 0.75) and number of drusen. In those with bilateral geographic atrophy (GA), symmetry between area of GA was moderate (agreement 72%, weighted κ = 0.54), and in those with bilateral neovascular disease (choroidal neovascularization or pigment epithelial detachment), symmetry was poor (agreement 45%, weighted κ = 0.16). Out of the entire cohort, 62% (n = 688) had neovascular disease in at least one eye and 37.5% of these had bilateral disease. The observed symmetry of phenotype between eyes with drusen appears to reduce in GA and neovascular forms of AMD. Overall, 53% of the cohort had symmetrical disease in terms of phenotype, 23% had neovascular disease in both eyes, 9.3% had GA in both eyes, and 39% of patients had neovascular disease in one eye and non-neovascular disease in the other. This may have implications for the potential need for anti-VEGF treatment of AMD in second eye involvement.
To determine whether grading based on the International Classification (IC) for age-related macul... more To determine whether grading based on the International Classification (IC) for age-related macular degeneration (AMD) allows recognition of change during the progression of the disease. Stereoscopic color fundus photographs of 50 eyes of 25 patients with AMD and at least 5 years of review were graded in a random and masked fashion for changes over time in the characteristics of drusen, pigmentary changes, and end-stage disease, according to the system defined by the IC for AMD, by two independent graders (F.B.S., I.L.). Fundus images were also analyzed in time sequence for clinical changes by a senior grader (I.L.) and two ophthalmologists (A.C.B., T.P.) without access to the grading forms of the IC grading. Clinical change, as recorded by the IC grading and the individual analysis, were compared. There was 97.8% (kappa = 0.70) concordance in identification of change. In four cases, the clinical classification differed from the IC grading: Two cases of drusen and two of end-stage disease grading. Inter-observer agreement for the IC grading was 89.4% for predominant phenotype (kappa = 0.84), 89.36-91.49% for presence of choroidal neovascularization (CNV) (kappa = 0.79-0.83), 87.23-89.36% for geographic atrophy (GA) (kappa = 0.62-0.74) and 55.32% for area covered by drusen (kappa = 0.31). Overall, progression from earlier stages of AMD to either of the two forms of advanced AMD were reflected accurately by the IC grading in the vast majority of cases.
AIMTo determine whether pharmacological mydriasis leads to a significant difference in interobser... more AIMTo determine whether pharmacological mydriasis leads to a significant difference in interobserver agreement of optic disc measurement compared with examination without mydriasis.METHODA cross sectional study was performed with a pair of observers examining the optic disc of two randomised groups of patients, one group before diagnostic mydriasis, and the other afterwards. Horizontal and vertical disc diameters and cup/disc ratios were
To study the characteristics of second treated eyes in patients with neovascular age-related macu... more To study the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the United Kingdom National Health Service. Multicenter national nAMD database study. Twelve thousand nine hundred fifty-one treatment-naïve eyes of 11,135 patients receiving 92,976 ranibizumab injections. Up to 5 years of routinely collected, anonymized data within electronic medical record systems were extracted remotely from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (loading phase of 3 monthly injections followed by monthly visits and pro re nata re-treatment). The minimum data set included: age, logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) at baseline and at all subsequent visits, and injection episodes. Baseline, change and actual VA over 3 years, and number of treatments and clinic visits. During the study, 1816 (16.3%) of the 11 135 patients received treatment to the fellow eye. Mean baseline and final VA were 0.66 (standard deviation, 0.32) and 0.65 (0.40) for first treated eyes and 0.41 (0.34) and 0.56 (0.40) for second treated eyes. The rate of VA loss after the loading phase was similar in first and second treated eyes (0.03 and 0.05 logMAR units/year). When fellow eyes with baseline VA worse than 20/200 were excluded to restrict analyses to eyes at risk of nAMD, the rate of second-eye involvement was 14.0% per year (42%/3 years). Mean number of injections/visits in years 1, 2, and 3 were similar for first and second treated eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4, and 3.8/9.1, respectively). Second treated eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better VA than first treated eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes which theoretically may reduce the benefits of extended monitoring regimens.
To identify and describe the different procedures used in the treatment of floppy eyelid syndrome... more To identify and describe the different procedures used in the treatment of floppy eyelid syndrome (FES) at Moorfields Eye Hospital and to evaluate their effectiveness.Cross-sectional study.A total of 71 patients who had undergone surgery for FES over a 13-year period since 1995 at Moorfields Eye Hospital were recruited. Retrospective data from 7 patients were also included, providing data for 78 patients.Patients underwent a full ocular examination. A survival analysis was determined by plotting Kaplan–Meier curves for each type of procedure encountered. Comparison of survival trends was made using a log-rank test. The possible effects of bias arising from bilaterality of the condition were investigated using a sensitivity analysis and a Cox regression analysis allowing for clusters. Tests for surgeon bias were made using the Fisher exact test.Recurrence of the condition. An assessment of recurrence was made clinically by 2 independent observers who were masked to the type of surgery the patient had undergone.Four different forms of surgical treatment were encountered: (1) Full-thickness wedge excision (FTWE) (26 patients, 33 procedures); (2) Upper lid lateral tarsal strip (LTS) (31 patients, 43 procedures); (3) Medial canthal (MC) and lateral canthal (LC) plication (15 patients, 19 procedures); (4) Medial tarsal strip (6 patients, 6 procedures). A total of 44 of 101 procedures had failed. Superior long-term survival outcomes of both LC/MC plication (P = 0.003) and upper lid LTS (P = 0.001) procedures over FTWE was demonstrated. However, survival comparison between the LC/MC plication and LTS groups did not achieve significance (P = 0.37). No significant difference in outcome between surgeon groups of equivalent experience was demonstrated (P = 0.18). No bias arising from bilaterality of the condition was identified.These data provide strong evidence of better survival outcomes in FES using the MC/LC plication and LTS procedures in comparison with the FTWE procedure. On the basis of experience from our unit, we recommend that the FTWE procedure be avoided as a form of treatment for FES in favor of the MC/LC plication, LTS, or medial tarsal strip procedure.The author(s) have no proprietary or commercial interest in any materials discussed in this article.
To evaluate the outcomes of phacoemulsification and intraocular lens (IOL) implantation in microp... more To evaluate the outcomes of phacoemulsification and intraocular lens (IOL) implantation in microphthalmos and nanophthalmos. Moorfields Eye Hospital, London, United Kingdom. Retrospective case series. Eyes with an axial length (AL) less than 21.0 mm had elective phacoemulsification and IOL implantation. One hundred three eyes (63 patients) were enrolled. The median AL was 20.65 mm (interquartile range [IQR], 20.26 to 20.86) and the median follow-up, 6.3 months. Complications occurred in 16 cases (15.5%). Zonular dehiscence, severe uveitis, and aqueous misdirection accounted for the majority of complications. Complication rates were 6 (7.3%) of 82 cases with an AL from 20.0 to 21.00 mm and 10 (47.6%) of 21 cases with an AL less than 20.0 mm (P=.0001). Only AL (odds ratio [OR], 0.52 per mm; P≤.0005) and abnormal intraocular pressure (IOP) of 22 mm Hg or more or on topical IOP control (OR, 10.1; P=.001) were significant independent risk factors for complications. For the cohort after adjusting for abnormal IOP, an AL less than 20.5 mm was associated with a 4 times higher odds of any complication (P=.028), an AL less than 20.0 mm was associated with a 15 times higher odds of any complication (P≤.0005), and an AL less than 19.00 mm was associated with a 21 times higher odds of any complication (P≤.0005). Phacoemulsification and IOL implantation in microphthalmos/nanophthalmos was challenging but appears safer than previously reported. A shorter AL and abnormal IOP were significant risk factors for complications.
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