Background factors determining the time to intraocular lens dislocation.

PURPOSE: To clarify the characteristics of intraocular lens (IOL) dislocation requiring IOL suture or intraocular scleral fixation. METHODS: This retrospective consecutive case series included 21 eyes (21 patients) who required sutured or sutureless intrascleral IOL fixation following IOL extraction owing to IOL dislocation at the outpatient clinic in the Department of Ophthalmology, Saitama Red Cross Hospital, Japan, between January and December 2019. Medical records were retrospectively reviewed for background diseases, location of the dislocated IOL (intracapsular/extracapsular), insertion of a capsular tension ring (CTR), and the period from IOL insertion to dislocation. RESULTS: We included 21 eyes of 21 patients who required IOL suture or intrascleral fixation for IOL dislocation at our clinic from January to December 2019 were included. The most common background disease was pseudoexfoliation syndrome (four cases), followed by atopic dermatitis, dysplasia/dehiscence of the zonule, post-retinal detachment surgery, high myopia, and uveitis (three cases each). At the time of dislocation, the IOLs were either intracapsular (16 cases, including 3 cases with CTR insertion) or extracapsular (5 cases). The time from IOL insertion to IOL dislocation was 13.7 ± 8.1 years (maximum: 31.3 years, minimum: 1.7 years). CONCLUSIONS: In this study, all 21 cases represented late IOL dislocations occurring after 3 months postoperatively. Among these late IOL dislocation cases, IOL dislocation occurred in a short-medium period of time, especially in those with CTR insertion and weakness/dehiscence of the zonule, with an average of 3 to 5 years postoperatively. We propose referring to these cases as intermediate-term IOL dislocation.

Observation on the tilt and decentration of multifocal intraocular lens with optic capture in Berger space for pediatric cataract.

PURPOSE: This study aimed to observe the tilt and decentration of multifocal intraocular lens (IOL) with optic capture in Berger space within 2 years after pediatric cataract surgery. METHODS: This is a prospective observational study. The implantation of multifocal IOL (Tecnis ZMB00) with optic capture in Berger space was performed on 33 patients (48 eyes) with pediatric cataract at Qingdao Eye Hospital. Tilt and decentration of IOL was measured using Scheimpflug system (Pentacam) at 1 month and 2 years postoperatively. RESULTS: All the multifocal IOLs were successfully implanted in Berger space with optic capture and no visually significant complications were detected during the follow-up. The mean tilt of IOLs was 2.779° ± 0.950° in the vertical plane and 2.399° ± 0.898° in the horizontal plane at 1 month postoperatively, and the mean length of the decentration was 0.207 ± 0.081 mm in vertical plane and 0.211 ± 0.090 mm in the horizontal plane. Compared with 1 month after surgery, the angle of tilt decreased by a mean of 0.192° and decentration increased by a mean of 0.014 mm at the vertical meridian at 2 years postoperatively (P = 0.37 and P = 0.27, respectively), meanwhile, tilt increased by 0.265° and decentration increased by 0.012 mm at the horizontal meridian (P = 0.11 and P = 0.22, respectively). CONCLUSIONS: The follow-up results suggest the tilt and decentration of multifocal IOL implantation with optic capture in Berger space remain stable in an acceptable range within 2 years after cataract surgery in children above the age of 5. TRIAL REGISTRATION: The study was approved by the Ethics Committee of Qingdao Eye Hospital, and registered on Chinese Clinical Trial Registry (ChiCTR identifier: 1900023155).

An analysis of the factors involved in IOL decentration after phacoemulsification using CASIA 2 anterior segment optical coherence tomography.

PURPOSE: To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. METHODS: 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. RESULTS: The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). CONCLUSION: Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.

Intraocular lens tilt and decentration in secondary ciliary sulcus implantation in paediatric eyes: A 3-year prospective study.

PURPOSE: The purpose of this study was to compare the tilt and decentration of one-piece anti-vaulting haptic intraocular lenses (IOL) and three-piece C-loop haptic IOLs in paediatric eyes undergoing secondary IOL implantation into the ciliary sulcus. METHODS: Paediatric aphakic patients receiving either one-piece anti-vaulting haptic or three-piece C-loop haptic IOL implants into the ciliary sulcus were enrolled in this prospective non-randomized interventional study and followed up for 3 years. IOL decentration and tilt were measured using Scheimpflug images. Preoperative and postoperative information, including demographic data and ocular biometric parameters and complications, were collected and analysed. RESULTS: Among 123 eyes of 79 paediatric patients, there were 72 eyes (58.54%) in the anti-vaulting haptic IOL group and 51 eyes (41.46%) in the C-loop haptic group. The anti-vaulting haptic IOL group had a lower incidence of clinically significant vertical IOL decentration than the C-loop haptic IOL group (23.88% vs. 43.14%, p = 0.037). No intergroup differences were observed in vertical or horizontal tilt or in horizontal decentration (all p > 0.05). One-piece anti-vaulting haptic IOL implantation was associated with a lower risk of clinically significant vertical decentration than three-piece C-loop haptic IOL implantation (odds ratio: 0.42, p = 0.037). There was a higher incidence of IOL dislocation in the C-loop haptic IOL group (15.22% vs. 4.17%, p = 0.046). CONCLUSIONS: In paediatric aphakic eyes undergoing secondary IOL implantation into the ciliary sulcus, one-piece anti-vaulting haptic IOLs can reduce the risk of clinically significant vertical IOL decentration compared with three-piece C-loop haptic IOLs and may favour long-term IOL positional stability.

Risk Factors Associated With Intraocular Lens Decentration After Cataract Surgery.

PURPOSE: To identify risk factors associated with intraocular lens (IOL) decentration after uneventful phacoemulsification with IOL implantation. DESIGN: A prospective cohort study. METHODS: All patients underwent a general ophthalmologic examination. One month postoperatively, the magnitude and orientation of IOL decentration relative to the visual axis center were assessed using an OPD-Scan III aberrometer, and the vertical and horizontal decentration values were determined. Univariate and multivariate linear regression analyses were performed to evaluate the association between the IOL decentration and ocular biometric parameters. RESULTS: In total, 143 eyes of 143 patients were enrolled. The mean decentration magnitude was 0.27 ± 0.15 mm, and the decentration axis appeared at any orientation, with no orientation tendency. The horizontal and vertical decentration were -0.02 ± 0.22 mm and 0.01 ± 0.22 mm, respectively. Multivariate regression analysis showed that the white-to-white distance and the magnitude of angle α were positively associated with the decentration magnitude (P < .001, adj. R2 = 0.121), the horizontal angle κ and horizontal angle α were positively associated with the horizontal decentration (P < .001, adj. R2 = 0.209), and the anterior chamber depth and vertical angle κ were positively associated with the vertical decentration (P < .001, adj. R2 = 0.152). CONCLUSIONS: The IOL decentration magnitude was greater in patients with a larger white-to-white distance and a larger angle α, the horizontal decentration was greater in patients with a larger horizontal angle κ and a larger horizontal angle α, and the vertical decentration was greater in patients with a deeper anterior chamber depth and a larger vertical angle κ. In these patients, premium IOLs should be implanted cautiously.

Repeated rotation of a toric implantable collamer lens: A case report.

INTRODUCTION: Implantable collamer lens have been used widely worldwide, and have been accepted by more and more doctors and patients due to good safety, stability, and effectiveness. However, there is still a problem of crystal rotation. The large angle rotation (over 10°) would weaken the original astigmatism correction effect and even induce irregular astigmatism, seriously affecting the visual quality of patients. Herein, we reported a case who had 2 times of crystal rotations after toric implantable collamer lens (TICL) implantation. PATIENT CONCERNS: The patient was a 38-year-old man who underwent TICL implantation for the correction of high myopic astigmatism in eyes. He presented a sudden decrease in the visual acuity (VA) of the left eye 4 months after the TICL implantation. The uncorrected visual acuity (UCVA) was 8/20 (refraction, +2.25 -5.25 × 68). DIAGNOSIS: Rotation of TICL was diagnosed. The toric marks with a rotation of 75° counter-clockwise from the original position were observed. INTERVENTIONS: The TICL was re-set to the original position, leading to the UCVA of 12/20 in the left eye (refraction, -0.00 -0.75 × 131), with the vaulting of 589 µm. Ten months after the TICL relocation, the patient again presented a sudden decrease in the VA of the left eye, with the UCVA of 2/20 (refraction, +2.25 -5.00 × 66). Again, the toric marks with a rotation of 75° counter-clockwise from the original position was observed, just at the same position as the last rotation. This time, the TICL was removed. The axis and power were recalculated, and a new TICL was implanted, with the rotation of 73° counter-clockwise from the horizontal line of the temporal side. OUTCOMES: The patient obtained a final UCVA of 12/20 in the left eye (refraction, +0.50 -0.50 × 26), which remained stable in the 6-month follow-up period, with the vaulting of 602 µm. LESSONS: Rotation is a common complication after TICL surgery. Relocation or replacement of TICL are safe and efficient ways to recover VA due to TICL rotation.

Scleral-Sutured Intraocular Lens Dislocations Secondary to Eyelet Fractures.

OBJECTIVE: To report clinical features and visual outcomes following eyelet fractures of scleral-sutured enVista MX60 (Bausch + Lomb) intraocular lenses (IOL). DESIGN: Retrospective, multi-center, multi-surgeon, observational case series. METHODS: Study Population: Patients with scleral-sutured enVista MX60 IOLs that experienced either an intraoperative or post-operative eyelet fracture associated with dislocation or subluxation. PROCEDURES: All records were reviewed for patients with a dislocated or subluxed scleral-sutured enVista MX60 IOL. Clinical features and outcomes were gathered. Main Outcome Measures: Clinical setting, surgical technique, complications, and visual acuity. RESULTS: A total of 25 scleral-sutured enVista MX60 IOLs displacements secondary to eyelet fractures in 23 eyes of 23 patients were included. There were 20 IOLs that sustained a postoperative fracture and 5 IOLs that sustained an intraoperative fracture. Of the postoperative fractures, 7 were dislocated and 13 were subluxed. Gore-Tex was the suture of choice for 19 of the postoperative fractures and all 5 of the intraoperative fractures, and Prolene was used for 1 postoperative fracture. The mean time until postoperative fracture was 96 ± 125 days, and the median time was 61 (IQR 48-144) days. Of the postoperative fractures, new MX60s were sutured in 10 patients, and 2 of them experienced repeat displacements due to a new eyelet fracture. In the intraoperative fracture group, new MX60s were sutured in 4 patients and an Akreos AO60 lens was placed in the 5th patient. The mean preoperative best-corrected logMAR visual acuity for all patients improved from 1.2 ± 0.8 (20/317 Snellen equivalent) to 0.5 ± 0.5 (20/63 Snellen equivalent) at most recent follow-up after lens replacement. CONCLUSIONS: Scleral-sutured MX60 intraocular lenses can experience intraoperative or postoperative eyelet fractures, resulting in lens subluxation or dislocation. Surgeons should be aware of this complication when evaluating secondary intraocular lens options.

Posterior segment Intra-Ocular Implant (IOL) dislocation: Predisposing factors, surgical management, outcome analysis.

PURPOSE: To evaluate the predisposing factors, management and visual prognosis of intraocular Lens (IOL) dislocation into the posterior segment. METHODS: The cases of posterior IOL dislocation from January 2012 to May 2017 at 2 centers were reviewed. Only eyes with dislocations requiring IOL explantation or repositioning were included. Predisposing factors, interval between cataract surgery and IOL dislocation, circumstances of onset, management, and postoperative complications are reported. RESULTS: 72 eyes of 72 patients were included. The mean age was 67.6 years. 47 patients (68%) were men. The mean time interval from cataract surgery to IOL dislocation was significantly shorter in the out-of-the bag group than the in-the-bag IOL dislocation group (3.8 months vs 132 months, P=0.002). Predisposing factors for out-of-the-bag IOL dislocation were mainly capsular rupture and/or zonular dehiscence (83%) after complicated cataract surgery. The predisposing factors for in-the-bag IOL dislocation were high myopia (40%), pseudoexfoliation syndrome (40%), previous vitrectomy (38%), or Marfan syndrome (3%) with uneventful cataract surgery. The type of luxated implant was mainly a 3-piece foldable IOL (50%), followed by foldable one-piece IOL (28%) and a rigid one-piece IOL (17%). Most cases of posterior chamber IOL dislocation occurred spontaneously (80%) without a trigger event. Management consisted of a posterior approach in 24 cases (33%) or an anterior approach in 48 cases (67%), associated with IOL repositioning in 20 eyes (28%), and IOL replacement in 34 eyes (47%). Finally, 18 eyes (25%) were left aphakic. Postoperative complications occurred in 7 cases (9.7%). CONCLUSIONS: Predisposing factors and time from cataract surgery to IOL dislocation were different for out-of-the bag versus in-the-bag IOL dislocation. Management of IOL dislocation varied considerably, depending on surgeon preference and experience. Surgery for IOL dislocation significantly improved best corrected visual acuity and was associated with a low complication rate.

Fracture of a polyimide-elastimide posterior chamber intraocular lens following blunt orbital trauma.

PURPOSE: Fracture of a three-piece polyimide-elastimide intraocular lens at the optic-haptic junction following blunt trauma is a possible complication after cataract surgery. We report a case of an isolated posterior chamber intraocular lens fracture caused by direct ocular blunt trauma. CASE: A 51-year-old patient underwent blunt orbital trauma caused by a raw chicken egg that was thrown at him, as he was walking. The posterior chamber intraocular lens was found in the anterior chamber, with a broken optic-haptic junction. The intraocular lens was exchanged, followed by iris fixation and pupilloplasty, with satisfactory postoperative anatomical and optical outcomes. DISCUSSION: The three-piece polyimide-elastimide intraocular lens was fractured at the optic-haptic junction. Although the fractured intraocular lens surface had a regular appearance, it has been previously reported that the polyimide haptic's durability is probably inferior to that of polymethylmethacrylate. Therefore, it is highly susceptible to shear stress induced by a blunt trauma. CONCLUSION: To our knowledge, this is an uncommon report of an implanted posterior chamber polyimide-elastimide intraocular lens fracture following blunt orbital trauma. Intraocular lens exchange and fixation had successful optical and anatomical results.

NITINOL FLEX LOOP-ASSISTED RETRIEVAL AND SUTURELESS INTRASCLERAL REFIXATION OF A DISLOCATED INTRAOCULAR LENS IMPLANT.

BACKGROUND/PURPOSE: To describe a novel use of the flexible nitinol loop membrane scraper (FINESSE Flex loop; Alcon, Fort Worth, TX) for rescue and refixation of a dislocated intraocular lens (IOL). METHODS: A 27-gauge nitinol flex loop was used to lasso each haptic of a dislocated 3-piece IOL. By retracting the loop, the haptic could be effectively locked to the instrument and externalized through a scleral tunnel, thereby fixating it to the sclera in a sutureless fashion. RESULTS: A 50-year-old man presented with a posteriorly dislocated Sensar AR40e IOL (Abbott Medical Optics, Inc; Santa Barbara, CA) and retained lens material after a complicated cataract surgery in the left eye. His visual acuity was counting fingers at face. The patient underwent 27-gauge pars plana vitrectomy with successful rescue and refixation of the IOL using the nitinol flex loop. One week postoperatively, his visual acuity had improved to 20/40. CONCLUSION: The nitinol flex loop may be used to lasso the haptics of a dislocated IOL and refixate it using a sutureless intrascleral fixation technique. This instrument may be a safer alternative compared with forceps for retrieving posteriorly dislocated IOLs that are sitting on the retinal surface.

Intraocular lens tilt and decentration after Nd:YAG laser posterior capsulotomy: Femtosecond laser capsulorhexis versus manual capsulorhexis.

PURPOSE: To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser-assisted capsulotomy versus manual capsulorhexis. SETTING: Ekol Eye Hospital, Izmir, Turkey. DESIGN: Retrospective case series. METHODS: Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. RESULTS: Eighteen eyes had a femtosecond laser-assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669). CONCLUSIONS: Nd:YAG posterior capsulotomy performed after femtosecond laser-assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser-created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Dislocated Intraocular Lens Extraction and Iris-Claw Lens Implantation in Vitrectomized and Non-vitrectomized Eyes

Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.

Long-Term Outcomes after Surgery for Late In-The-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial.

PURPOSE: To compare the long-term efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. DESIGN: Prospective, randomized, parallel group surgical clinical trial. METHODS: During a 3-year period, 104 patients (104 eyes) were assigned one group for IOL repositioning by scleral suturing (n = 54) or one group for IOL exchange by retropupillary fixation of an iris claw IOL (n = 50). A single surgeon performed all operations using an anterior approach. Patients were examined before surgery and at 6 months and 1 and 2 years after surgery. The present study included the 66 patients (63%) who completed the 2-year follow-up, and the main outcaome measurement was corrected distance visual acuity (CDVA) 2 years after surgery. RESULTS: After 2 years, the mean CDVA was 0.20 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range, -0.10 to 1.22) in the exchange group (P = .69). A CDVA of 20/40 or better was achieved by 76% of all patients. Four eyes (12%) had cystoid macular edema in the repositioning group compared with 5 eyes (15%) in the exchange group. Two eyes underwent redislocation (1 in each group). There were no cases of endophthalmitis or retinal detachment. CONCLUSIONS: There were no significant differences between the visual acuity using IOL repositioning and that using IOL exchange 2 years after surgery. The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.

In-the-bag dislocation of polyfocal full-optics accommodative intraocular lens: A case report.

Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.

Repositioning a posteriorly dislocated silicone plate-haptic toric intraocular lens.

We describe a technique for repositioning an encapsulated, posteriorly dislocated silicone plate-haptic toric intraocular lens (IOL) while preventing further dislocation into the vitreous cavity. Sutures of 10-0 polypropylene were used to ensure safe retrieval of the dislocated IOL. An anterior vitrectomy was then performed to remove the contracted capsular bag around the IOL. The IOL fixation hole was temporarily externalized to allow quick and secure IOL fixation, eliminating the risk for losing the slippery silicone IOL into the vitreous cavity. Using this technique, the IOL was successfully placed in the proper position and resulted in good vision for the patient while avoiding the trauma of lens exchange.

Pars plana vitrectomy with transscleral fixation of posterior chamber lens in the treatment of post-traumatic lens dislocation.

PURPOSE: To present our experience with post-traumatic lens dislocation management by vitrectomy followed with sutureless artificial lens fixation. METHODS: The retrospective study involved 15 patients (12 men and 3 women) aged from 36 to 78 (on average, 63 years old), from the Vitreoretinal Surgery Teaching Hospital, operated in the years 2013-2015. All cases concerned ocular traumas with dislocation of the natural or artificial lens to the anterior chamber, vitreous body chamber, or post-traumatic aphakia. After vitrectomy, patients had the implant fixated with a technique devised by Scharioth-sutureless fixation of posterior chamber implants in the groove area, with haptics placed in scleral tunnels parallel to the corneal limbus. Preoperative and postoperative condition of the eye was assessed. RESULTS: The average period of observation was 29 weeks. Average pre-surgery refraction was + 10.75, while post-surgery + 1.25. Average best-corrected visual acuity in Snellen charts before surgery was 0.3 and at the end of the observation period 0.5. The improvement in visual acuity after surgery in relation to visual acuity before surgery was statistically significant (P = 0.005). In the first 2 weeks after surgery, minor hypotonia was observed in three of the patients, while in two-moderate bleeding to the vitreous body and the anterior chamber, which subsided without surgical intervention. A slight decentration of the implant observed in two cases did not affect later refraction or BCVA. CONCLUSION: Basing on the abovementioned facts, we believe that this surgical approach facilitates the fixation of the dislocated lens and allows a successful treatment of secondary implantation or repositioning of a dislocated intraocular lens.

True rotational stability of a single-piece hydrophobic intraocular lens.

BACKGROUND: To evaluate rotation and its influencing factors of an aspheric one-piece hydrophobic acrylic intraocular lens (IOL) Vivinex XY1 during 6 months after operation. METHODS: In this institutional trial, 122 eyes of 66 patients were implanted with a non-toric aspheric IOL Vivinex XY1 (Hoya Corporation, Tokyo, Japan). IOL alignment was assessed at the end of surgery, 1 hour, 1 week, 1 month and 6 months after implantation. Confounding factors such as axial length, presence of anterior fibrosis and randomised implantation in four different intended axes (0°, 45°, 90°, 135°) were evaluated. Decentration and tilt were measured using a Purkinje metre. RESULTS: Assessment of rotational stability was possible for 103 of 122 implanted IOLs 6 months after eye surgery. The median absolute rotation was 1.1° (range: 0°-5°). Rotation was significantly increased within the first hour after operation compared with later time-points (p<0.001). No correlation was found with axial length and rotation (Spearman's r=0.048, p=0.63). No significant difference was observed regarding different implantation axes (p=0.75). Rotation was not influenced by the presence of anterior fibrosis (p=0.98). CONCLUSION: Assessing the true IOL position at the end of surgery is crucial for the evaluation of rotational stability of IOLs. No IOL rotation exceeding 5° could be detected 6 months after surgery.

Assessment of long-term intraocular lens (IOL) decentration and tilt in eyes with pseudoexfoliation syndrome (PES) following cataract surgery.

BACKGROUND: To evaluate long-term intraocular lens (IOL) decentration and tilt in eyes with pseudoexfoliation syndrome (PES) following cataract surgery using Visante anterior segment OCT and iTrace Visual Function Analyzer. METHODS: Sixty-four eyes following cataract surgery from 2009 to 2012 were included, 34 eyes had PES and 30 eyes did not show PES. A standard phacoemulsification procedure followed by IOL implantation was performed and patients were followed 4-6 years after surgery (mean = 69 months). Best-corrected visual acuity (BCVA), capsulorhexis size, and intraocular pressure (IOP) were measured. IOL decentration and IOL tilt were evaluated using Visante Omni anterior segment OCT (Carl Zeiss Jena GmBH, Germany). The iTrace VFA (Visual Function Analyzer, Hoya surgical optics) was used to measure corneal, internal, and total optical aberrations. RESULTS: Measurements with iTrace showed that horizontal coma was significantly different between PES and control eyes (p = 0.037). Horizontal as well as vertical tilt showed a significant difference between PES and control eyes (p = 0.035 and p = 0.039). Tilt correlated with capsulorhexis size in PES patients (p = 0.011). This indicates a forward tilt of the superior edge of the IOL in eyes with PES. CONCLUSIONS: Patients affected by PES seem to have a higher risk for long-term complications and changes in visual perception due to IOL tilt and decentration after cataract surgery.