Bilateral implantation of +56 and +58 diopter custom-made intraocular lenses in patient with extreme nanophthalmos

PURPOSE: To present the case of a 60-year-old patient with severe nanophthalmic eyes, who underwent cataract surgery with a bilateral implantation of custom-made high-power intraocular lenses (IOLs). OBSERVATIONS: The axial length was 14.94 and 15.05 mm of the right and the left eye, respectively. The preoperative corrected distance visual acuity (CDVA) was +0.46 logMAR (20/63) in the right eye and +0.58 logMAR (20/80) in the left eye with rigid contact lenses of +17.5 D bilaterally. The calculated IOL power for emmetropia with different formulas ranged from +55.28 to +70.09 D. The IOL power selection was based on the average value from four formulas (Haigis, Holladay 1, Holladay 2, SRK/T) with the target refraction of emmetropia. Custom-made +56.0 and + 58.0 D Aspira-aAY IOLs (HumanOptics AG, Erlangen, Germany) were implanted without any complications. The postoperative CDVA was +0.40 logMAR (20/50) and +0.60 logMAR (20/80). The manifest refraction spherical equivalents were +0.625 D and −0.375 D. CONCLUSIONS AND IMPORTANCE: Even in eyes with the axial length of only 15 mm, cataract surgery can be successfully performed after adequate preparation. High-power customized IOLs allow complete correction of hyperopia but caution is required with the results from different IOL power calculation formulas, which can be misleading.