We read with interest the article “Cataract Surgery in Eyes with Nanophthalmos and Relative Anterior Microphthalmos” by Jung and associates. The authors stated that cataract surgery results were encouraging in nanophthalmic eyes that underwent the current phacoemulsification approach and that there was no uveal effusion or choroidal hemorrhage in their series.

Although the cases reported in their series fit the description of nanophthalmos (axial length less than 20.5 mm), the mean axial length in this study was 19.53 ± 1.17 mm. Hence, the inference of no complications could be misleading. We believe that shorter eyes with axial lengths closer to the lower end of the spectrum, that is, approximately 14 mm, are at higher risk of having complications. A thick sclera is known to cause compression of the vortex veins, resulting in choroidal effusion that can occur spontaneously, during surgery, or after surgery. Intraoperative measures such as vortex vein decompression or scleral resection have been suggested to minimize such intraoperative complications.

In our series of 11 nanophthalmos eyes, in which the mean axial length was 16.5 ± 1.2 mm, we observed serous uveal effusion in 1 eye and hemorrhagic choroidal detachment in 1 eye despite prophylactic 4-quadrant sclerectomy. Hence, it is our contention that the lack of complications in the series reported by Jung and associates is because all their cases belonged to the longer end of the spectrum of nanophthalmos. The results of their study would have been more conclusive if the authors had included eyes with shorter axial lengths closer to the lower end of the spectrum.