Treatment of angle-closure glaucoma secondary to nanophthalmos: A review of surgical strategies and novel approaches

Abstract: Nanophthalmos presents a significant management challenge when complicated by angle-closure glaucoma, primarily due to the high risk of sight-threatening perioperative complications such as malignant glaucoma and uveal effusion syndrome. This review aims to address the key question of optimal evidence-based surgical strategies for Nanophthalmos secondary to angle-closure glaucoma (NSACG) that effectively mitigate these characteristic risks. The main contribution of this review is the proposal of a novel modular surgical approach, which selectively integrates phacoemulsification (phaco), irido-zonulo-hyaloid-vitrectomy, goniosynechialysis or Ahmed glaucoma valve implantation, and scleral windows. Grounded in the pathophysiological mechanisms underlying surgical complications, this modular framework synthesizes current evidence to provide a personalized and scientifically grounded strategy for managing this refractory glaucoma subtype.