Abstract:  Objective  To investigate the efficacy and complications of different combined lens surgeries for secondary glaucoma in nanophthalmos. Design Retrospective case series. Participants Sixty-eight patients (68 eyes) suffered from secondary angle-closure glaucoma with nanophthalmos (axial length ≤20.5 mm) who underwent combined lens surgery at Fudan University Eye and ENT Hospital between October 2015 and November 2023. Methods Patients were divided into three groups according to surgical approach: Group A (phacoemulsification combined with goniosynechialysis, 18 eyes), Group B (phacoemulsification combined with goniosynechialysis and sclerectomy, 12 eyes), and Group C (phacoemulsification combined with goniosynechialysis, sclerectomy, and anterior vitrectomy, 38 eyes). All patients were followed up for more than 6 months postoperatively. Complete intraocular pressure (IOP) control was defined as IOP ≤21 mmHg without antiglaucoma medications. Malignant glaucoma, choroidal detachment, suprachoroidal hemorrhage, and retinal detachment were considered severe complications. Main Outcome Measures  Complete IOP control rate, visual acuity maintenance rate, incidence of severe complications, and reoperation rate. Results  At the final follow-up, in Group A, Group B, Group C, the complete IOP control rates were 50.0% (9 eyes), 83.3% (10 eyes), and 81.6% (31 eyes) respectively; the visual acuity maintenance rates were 77.8% (14 eyes), 66.7% (8 eyes), and 52.6% (20 eyes), respectively; the incidences of severe complications were 22.3% (4 eyes), 16.7% (2 eyes), and 13.2% (5 eyes), respectively； the reoperation rates were 27.8% (5 eyes), 16.7% (2 eyes), and 5.3% (2 eyes), respectively. Compared with Group A, Group C demonstrated significantly better IOP control (P=0.025) and lower reoperation rate (P=0.029), although the difference in visual acuity decline was not statistically significant (P=0.087). Compared with Group A, Group B showed higher IOP control rate (P=0.121) and lower reoperation rate (P=0.669), but neither reached statistical significance; however, visual function was better preserved in Group B (P=0.678). The incidence of severe complications was highest in Group A, followed by Group B and Group C, though no statistically significant differences were observed among the groups. Conclusions The surgical approach combining phacoemulsification, goniosynechialysis, sclerectomy, and anterior vitrectomy provides favorable single-surgery IOP control with relatively low complication rates, making it suitable for extremely high-risk eyes prioritizing IOP control and reduction of reoperations. The approach combining phacoemulsification, goniosynechialysis, and sclerectomy offers better preservation of visual function and is more appropriate for patients with acceptable visual reserve but high anatomical risk. Both represent viable surgical options for secondary glaucoma in nanophthalmos..

Key words: Nanophthalmos, Secondary glaucoma, Combined lens surgeries