We thank Dr Lingam and associates for their interest and comments on our article. We demonstrated that our cataract surgery experience in 17 nanophthalmic eyes was encouraging, but revealed a higher rate of complications compared with those of the relative anterior microphthalmic eyes or the normal control eyes.

The axial length of nanophthalmos is at least 2 standard deviations less than the mean for age or less than 20.5 mm. Previously, Wu and associates diagnosed nanophthalmos based on a shorter than average axial length (usually less than 21.0 mm), and Yuzbasioglu and associates defined nanophthalmos according to axial length less than 20.0 mm. Our study defined nanophthalmos as an axial length of less than 20.5 mm without morphologic malformation.

We enrolled patients who fulfilled the defined criteria of nanophthalmos in a designated period. In our study, the proportion of extremely short eyes was not high. In our study, the smallest axial length was 16.9 mm. The patient did not show specific complication such as choroidal hemorrhage or uveal effusion in our study. In our study, we could not find extremely short eyes with an axial length of approximately 14 mm. As Dr Lingam suggested, the postoperative outcome would be more unfavorable with uveal effusion if more extremely short eyes had been included.

In another study of cataract surgeries in nanophthalmic eyes, the smallest eye with an axial length of 15.82 mm did not show uveal effusion. The results of cataract surgery in short eyes may depend on various factors (race, preoperative preparation), as well as the characteristics of eyes such as an axial length, anterior chamber depth, and so forth. Further studies of cataract surgeries in nanophthalmic eyes may be valuable if they included extremely short eyes and divided subgroups according to axial length.