A shortened axial length with choroidal thickening is often accompanied by chronic hypotony and posterior scleral flattening. Hypotony makes biometry technically challenging and complicates calculation of IOL power. The clinician should attempt to determine the cause of hypotony and undertake specific treatment before cataract surgery. If the cataract obscures examination of the posterior segment, B-scan ultrasonography is helpful in revealing posterior segment pathology. A cyclodialysis cleft or retinal detachment requires a more extensive procedure when combined with cataract surgery. Severe hypotony or prephthisis is a poor prognostic indicator for improvement in vision after cataract extraction.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.