Analysis of higher-order aberrations in eyes having undergone intraocular lens suturing

Effects of tilt and decentration of Visian Implantable Collamer Lens (ICL V4c) on visual quality: an observational study

Background

The central hole of the Visian Implantable Collamer Lens (ICL V4c) provides a reference to observe its tilt or decentration. This study aimed to investigate the tilt and decentration effects of ICL V4c on visual quality after implantation.

Methods

A total of 135 eyes from 69 patients who underwent ICL V4c implantation were included in this study. Evaluation of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and aberrations were performed 6-months postoperatively. The anterior segment parameters were collected using CASIA2 anterior segment-optical coherence tomography, tilt and decentration of ICL V4c were analyzed using MATLAB software. All patients received questionnaires to investigate the visual quality postoperatively.

Results

The safety and effectiveness were 1.18 ± 0.17 and 1.11 ± 0.18, respectively. No significant changes were observed regarding higher-order and spherical aberrations after the operation; however, coma and trefoil significantly increased compared to preoperative values. The average total decentration and tilt was 0.21 ± 0.12 mm and 2.54 ± 1.00°, respectively. Horizontal, vertical, and total values of tilt and decentration were not significantly associated with postoperative CDVA, UDVA, and aberrations. The most common visual symptom was halo, and 97.04% of patients had a satisfaction score ≥ 8. The total or horizontal tilt was significantly positively correlated with the frequency, severity, and bothersome scores from the questionnaires.

Conclusions

ICL V4c implantation can obtain high visual quality and patient satisfaction. Although the degree of tilt and decentration after ICL V4c implantation was small, a positive effect on subjective visual quality was observed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02499-4.

Intrascleral Intraocular Lens Fixation Preserving the Lens Capsule in Cases of Cataract with Insufficient Zonular Support

Purpose

To report our modified simple technique for optic capture and the clinical results of intrascleral IOL fixation preserving the lens capsule, without vitrectomy, in cases of cataract with insufficient zonular support to stabilize the intraocular lens (IOL).

Patients and Methods

In 37 eyes of 25 patients with phacodonesis and two or more risk factors for progressive zonular insufficiency, we inserted a CTR to support the capsule and zonules during cataract surgery and IOL fixation; an optic was inserted into the lens capsule, and a haptic was fixed in the scleral tunnel without vitrectomy. In all cases, anterior or total vitrectomy was not needed.

Results

The postoperative mean (± standard deviation) tilt and decentration of the implanted IOL did not change from 6 to 12 months (6.77 ± 3.15° to 6.33 ± 3.38° and 0.60 ± 0.30 to 0.61 ± 0.35 mm, respectively). We encountered no late IOL dislocation and no retinal complications, including retinal breaks or cystoid macular oedema, postoperatively (follow-up = 21.1 ± 5.2 months).

Conclusion

Our modified techniques preclude the need for vitrectomy. If the lens capsule can be preserved using a CTR, our modified technique can be used to stabilize IOL.

Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography

Purpose

To investigate the tilt and decentration of the crystalline lens and the intraocular lens (IOL) relative to the corneal topographic axis using anterior segment ocular coherence tomography (AS-OCT).

Methods

A sample set of 100 eyes from 49 subjects (41 eyes with crystalline lenses and 59 eyes with IOLs) were imaged using second generation AS-OCT (CASIA2, TOMEY) in June and July 2016 at Okayama University. Both mydriatic and non-mydriatic images were obtained, and the tilt and decentration of the crystalline lens and the IOL were quantified. The effects of pupil dilation on measurements were also assessed.

Results

The crystalline lens showed an average tilt of 5.15° towards the inferotemporal direction relative to the corneal topographic axis under non-mydriatic conditions and 5.25° under mydriatic conditions. Additionally, an average decentration of 0.11 mm towards the temporal direction was observed under non-mydriatic conditions and 0.08 mm under mydriatic conditions. The average tilt for the IOL was 4.31° towards the inferotemporal direction relative to the corneal topographic axis under non-mydriatic conditions and 4.65° in the same direction under mydriatic conditions. The average decentration was 0.05 mm towards the temporal direction under non-mydriatic conditions and 0.08 mm in the same direction under mydriatic conditions. A strong correlation was found between the average tilt and decentration values of the crystalline lens and the IOL under both non-mydriatic and mydriatic conditions (all Spearman correlation coefficients, r ≥ 0.800; all P < 0.001).

Conclusion

When measured using second generation AS-OCT, both the crystalline lens and the IOL showed an average tilt of 4–6° toward the inferotemporal direction relative to the corneal topographic axis and an average decentration of less than 0.12 mm towards the temporal direction. These results were not influenced by pupil dilation and they showed good repeatability.