Penetrating Canaloplasty Combined with Anterior Vitrectomy and Partial Ciliary Body Cauterization for Secondary Angle-Closure Glaucoma in Nanophthalmos: A Two-Case Report

Background Nanophthalmos (NO) is a rare congenital condition often associated with secondary angle-closure glaucoma. Due to structural abnormalities, nanophthalmic eyes are prone to serious postoperative complications such as uveal effusion, malignant glaucoma, and explosive suprachoroidal hemorrhage following filtering surgeries. Penetrating canaloplasty (PCP) is a modified version of canaloplasty (CP) and a minimally invasive glaucoma surgery (MIGS) that does not rely on a filtering bleb. It is not limited by angle anatomy and has broad indications, making it particularly suitable for angle-closure glaucoma. This report presents two cases treated with PCP combined with anterior vitrectomy and partial ciliary body cauterization, highlighting the potential therapeutic value of this surgical approach in eyes with complex anterior segment anatomy and strategies for managing postoperative complications. Case presentation We report two cases of NO with secondary angle-closure glaucoma, both of whom underwent bilateral penetrating canaloplasty combined with anterior vitrectomy and partial ciliary body cauterization. Postoperative follow-up durations were 3 and 7 months, respectively. Intraocular pressure (IOP) remained well controlled in both patients without the need for additional antiglaucoma medications. One case showed no significant postoperative complications, while the other developed choroidal detachment, which resolved well with conservative treatment. Conclusions PCP combined with anterior vitrectomy and partial ciliary body cauterization may be a feasible option for managing secondary angle-closure glaucoma in nanophthalmic eyes. It provides effective IOP control without blebs. The differing postoperative recoveries of the two patients prompt further reflection on individual anatomical variations and potential risk factors—such as axial length and gender—that may influence surgical outcomes. Emphasizes the importance of comprehensive preoperative evaluation and risk management.