Nanophthalmos is a congenital condition in which there is a small eye with a thickened sclera and normal-sized lens. This patient with nanophthalmos presented with mature cataracts in both eyes and had a refractive error of +13.00 D. During her evaluation for cataract extraction, the patient's axial eye length was found to be 17.14 mm OD and 17.04 mm OS. She had normal-sized lenses which were large relative to her small eyes. As one can see in the B-scan ultrasound, her sclera is almost 2.4 mm thick. For surgical planning, the decision was made to use piggyback intraocular lens implants to meet her refractive requirements and prophylactic scleral windows to reduce the risk of choroidal effusion.
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