IOL Eye Surgery Planning | Small Eye

Published on August 31, 2026 by Dr Muhammad Azeem with the help of AI which helped him organise his thoughts

This case involves a young aphakic patient with a small eye who requires a high-power, +30 D secondary IOL. Planning a safe sulcus implantation in an eye like this means working through the following points carefully, one at a time.

1. Estimation of the IOL power should be careful

   This is the most important step in planning part of the surgery. The goal should be realistic and well explained to the patient. As sometimes Large power IOL like above +30 are not available. Even with the largest available power the patient end up being undercorrected.

2. Assessment of the Ciliary Sulcus

   The ciliary sulcus should be assessed for space and direction of the cilairy body. If the ciliary body is directed forwards it is normal and a vitreous facing ciliary body can lead to aqueous misdirection , which can cause very high IOP a condition known as malignant glaucoma.

3. Ultrasound Biomicroscopy (UBM)

   This test is done for the assessment of the anterior segment of the eye specially ciliary body area and iridocorneal angle. However, this test is not easily available. But it is not a replacement of Anterior segment OCT . As Anterior segment OCT does not explains the area in sufficent detail to make a clear decision.

4. Use of Steroids

   Small eyes are particularly prone to develop choroidal effusion because of thick sclera. Using periocular steroids will decrease the chances of this particular complication in these eyes.

5. Systemic Steroid Planning

   Consider systemic corticosteroids when clinically indicated, after evaluating the patient’s ocular anatomy, risk of uveal effusion syndrome, and any systemic contraindications.

6. Choice of IOL

   Multipiece IOL are the best choice IOL. As the heptics of these IOL are prolene made and thin. So in a already tight space they do not push the iris. The large heptics can cause obstruction in aqueous drainage leading to raised intraocular pressure. Make sure the heptics are placed in inverted S shape which will lead to posterior vault of the IOL and will not cause pupil block glaucoma.