Researchers recently reported that a history of pars plana vitrectomy (PPV) and short axial length (AL) were associated with greater intraocular lens (IOL) tilt, while longer AL, thicker lens and overlarge capsulorhexis contributed to greater decentration.

This cross-sectional study evaluated 196 eyes of 196 patients who underwent phacoemulsification for cataract extraction and IOL implantation surgery. A team conducted general ophthalmologic examinations and anterior segment photography to assess IOL tilt and decentration.

They discovered that the IOLs had an average tilt of 4.8° toward the inferotemporal direction and an average decentration of 0.21mm. They noted that 11.22% had a tilt greater than 7.0° and 10.72% had a decentration greater than 0.40mm. They added that previous PPV and short AL were associated with greater IOL tilt, and long AL, thicker lens and less capsulorhexis-IOL overlap were positively correlated with IOL decentration. The investigators did not observe a direct correlation between corrected distance visual acuity and IOL tilt or decentration.

“These findings suggest that choosing a toric and multifocal IOL might be prudent in patients with a history of PPV surgery or shorter or longer axial length, because these IOLs are more dependent on alignment with the visual axis to achieve the best visual quality,” the study authors concluded in their paper. “An appropriate capsulorhexis size that covers IOL edge perfectly should be warranted in cataract patients, especially in patients with hypermyopia or thicker lenses.

Chen X, Gu X, Wang W, et al. The characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg. April 21, 2020. [Epub ahead of print].