Definition of Intraocular Lens Position after Suture Fixation to the Iris in Remote Post-Op Period with Optical Coherence Tomography

Introduction. Intracapsular IOL position is optimal from optical point of view and in anatomical sense results in formation of a new structure — IOL-capsular bag complex (ICBC). Stable IOL position in post-op period in some cases may be disturbed in some cases due to capsular bag fibrosis or progressive involution zonulolysis against the background of pseudoexfoliation syndrome. The disturbance of correct IOL optic part position (tilt/decentration) results in a decrease of visual acuity and appearance of optic aberrations. ICBC is a dynamic structure from architectonic point of view. Fibrosis of capsular sheets and increase of equatorial cortex (Zommering ring) may result to IOL shift in long term post-op period. Accurate definition of these parameters is crucial for estimation of impact on visual functions. The existing methods of IOL position definition are based on various principles, therefore, it is not correct to compare the parameters obtained with various devices.

Pursope. To develop a method of IOL tilt and decentration definition with optical coherence tomography (Optovue, AS-OCT) and to define these parameters after suture fixation of IOL-capsular bag complex to the iris in remote post-op period.

Methods. The parameters of 50 eyes operated from 2014 to 2016 for ICBC dislocation were estimated. The patients were examined again in 5 years or later. Definition of IOL position was performed with optical coherence tomography (Optovue, ASOCT) using Cornea Crossline protocol. For estimation of obtained parameters and their deviation from normal the study group was compared with a control group of 30 pseudophakic eyes with high uncorrected visual acuity.

Results. In the study group the following data was obtained. Mean value of IOL tilt angle was 3.02 ± 2.04° in the horizontal meridian and 2.39 ± 1.4° in the vertical meridian. Decentration from the center of non-mydriatic pupil was 396 ± 222 microns in the horizontal meridian and 455 ± 278 microns in the vertical meridian. In the control group mean value of IOL tilt angle was 3.04° ± 1.28° in the horizontal meridian and 1.43° ± 0.53° in the vertical meridian. Decentration from the center of non-mydriatic pupil was 190 ± 114 microns in the horizontal meridian and 259 ± 108 microns in the vertical meridian. The difference between the groups is statistically significant (p < 0,05).

Conclusion. The developed method allows non-contact definition of IOL position (tilt/decentration) with optical coherence tomography (Optovue, AS-OCT). The obtained data shows stable correct frontal position of IOL optic part in remote post-op period after suture fixation of ICBC to the iris. 

1. Kamiya K., Igarashi A., Hayashi K., Negishi K., Sato M., Bissen-Miyajima H. A multicenter prospective cohort study on refractive surgery in 15 011 eyes. Am J Ophthalmol. 2017;175:159–168. DOI: 10.1016/j.ajo.2016.12.009

2. Belonozhenko Ya.V., Sorokin E.L. Prevention of «IOL — capsular bag» dislocation in patients with mild degree of lens subluxation at the time of cataract phacoemulsification. Ophthalmology journal = Oftal’mologicheskiye vedomosti. 2012;5(3):42–47 (In Russ.).

3. Hoffman R., Fine I., Packer M. Scleral fixation without conjunctival dissection. J. Cataract Refract. Surg. 2006;11(32):1907–1912. DOI: 10.1016/j.jcrs.2006.05.029

4. Szurman P., Petermeier K., Aisenbrey S. Z-suture: a new knotless technique for transscleral suture fixation of intraocular implants. Br. J. Ophthalmol. 2010;2(94):167–169. DOI: 10.1136/bjo.2009.162180

5. Kozhuhov A.A., Kapranov D.O., Kazakova M.V. Our experience of fixation of the posterior chamber IOL after phacoemulsification of cataract complicated by a violation of the capsular support of the lens. Clinical cases. Russian Ophthalmological Journal = Rossiyskiy oftal’mologicheskiy zhurnal. 2018;2(11):54–57 (In Russ.). DOI: 10.21516/2072-0076-2018-11-2-54-57

6. Ivanov D.I., Kremeshkov M.V., Bardasov D.B. Technology and results of treatment of luxated and subluxated complexes of an intraocular lens with a capsular bag. Modern technologies of cataract and refractive surgery = Sovremennye tekhnologii kataraktal’noy i refrakcionnoy hirurgii. 2011;4:23–24 (In Russ.).

7. Soiberman U., Pan Q., Daoud Y. Iris suture fixation of subluxated intraocular lenses. Am. J. Ophthalmol. 2015;159:353–359. DOI: 10.1016/j.ajo.2014.11.009

8. Hayashi K., Hayashi H., Nakao F., Hayashi F. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens. Ophthalmology. 2001;108:2011–2017. DOI: 10.1016/S0161-6420(01)00756-4

9. Turuwhenua J. Reconstructing ocular surfaces by Purkinje images using an exact ray approach: Estimating IOL decenter and tilt. Ophthalmic Physiol. Opt. 2010;30:43–54. DOI: 10.1111/j.1475-1313.2009.00692.x

10. Sasaki K., Sakamoto Y., Shibata T., Nakaizumi H., Emori Y. Measurement of postoperative intraocular lens tilting and decentration using Scheimpflug images. J. Cataract Refract. Surg. 1989;15:454–457. DOI: 10.1016/S0886-3350(89)80071-9

11. Ang G.S., Duncan L., Atta H.R. Ultrasound biomicroscopic study of the stability of intraocular lens implants after phacoemulsification cataract surgery. Acta Ophthalmol. 2012;90:168–172. DOI: 10.1111/j.1755-3768.2010.01880.x

12. Wang X., Dong J., Wu Q. IOL tilt and decentration estimation from 3 dimensional reconstruction of OCT image. PLoS ONE. 2013;8:e59109. DOI: 10.1371/journal.pone.0059109

13. de Castro A., Rosales P., Marcos S. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation study. J. Cataract Refract. Surg. 2007;33:418–429. DOI: 10.1016/j.jcrs.2006.10.054

14. Phillips P., Pérez-Emmanuelli J., Rosskothen H.D., Koester C.J. Measurement of intraocular lens decentration and tilt in vivo. J. Cataract Refract. Surg. 1988;14:129– 135. DOI: 10.1016/S0886-3350(88)80086-5

15. Nishi Y., Hirnschall N., Crnej A., Gangwani V., Tabernero J., Artal P., Findl O. Reproducibility of intraocular lens decentration and tilt measurement using a clinical Purkinje meter. J. Cataract Refract. Surg. 2010;36:1529–1535. DOI: 10.1016/j.jcrs.2010.03.043

16. Uzel M.M., Ozates S., Koc M., Taslipinar Uzel A.G., Yılmazbaş P. Decentration and tilt of intraocular lens after posterior capsulotomy. Semin. Ophthalmol. 2018;33:766–771. DOI: 10.1080/08820538.2018.1443146

17. Rosales P., De Castro A., Jiménez-Alfaro I., Marcos S. Intraocular lens alignment from purkinje and Scheimpflug imaging. Clin. Exp. Optom. 2010;93:400–408. DOI: 10.1111/j.1444-0938.2010.00514.x

18. Marianelli B.F., Mendes T.S., de Almeida Manzano R.P., Garcia P.N., Teixeira I.C. Observational study of intraocular lens tilt in sutureless intrascleral fixation versus standard transscleral suture fixation determined by ultrasound biomicroscopy. Int. J. Retina Vitreous. 2019;5:33. DOI: 10.1186/s40942-019-0182-y

19. Li L., Wang K., Yan Y., Song X., Liu Z. Research on calculation of the IOL tilt and decentration based on surface fitting. Computational and Mathematical Methods in Medicine. Mathematical Methods in Biomedical Imaging. 2013. DOI: 10.1155/2013/5725303

20. Mura J.J., Pavlin C.J., Condon G.P., Belovay G.W., Kranemann C.F., Ishikawa H., Ahmed I.I.K. Ultrasound biomicroscopic analysis of iris-sutured foldable posterior chamber intraocular lenses. Am. J. Ophthalmol. 2010;149:245–252.e2. DOI: 10.1016/j.ajo.2009.08.022

21. Vasavada A.R., Raj S.M., Karve S., Vasavada V., Theoulakis P. Retrospective ultrasound biomicroscopic analysis of single-piece sulcus-fixated acrylic intraocular lenses. J. Cataract Refract. Surg. 2010;36:771–777. DOI: 10.1016/j.jcrs.2009.11.027

22. Chen X., Gu X., Wang W., Xiao W., Jin G., Wang L., Dai Y., Zhang E., Ruan X., Liu Z. The characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J. Cataract Refract. Surg. 2020;46:1126–1131. DOI: 10.1097/j.jcrs.0000000000000219

23. Ale J.B. Intraocular lens tilt and decentration: A concern for contemporary IOL designs. Nepal. J. Ophthalmol. 2011;3:68–77. DOI: 10.3126/nepjoph.v3i1.4281