Study on influencing factors of intraocular lens position after cataract surgery_West China Medical Journal

Authors：

XU Feng , MU Jiancheng , YANG Ning , GUO Wanyue , SUN Chuhuan , PENG Bosen ,  FAN Wei

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FAN Wei, Email: fanwei55@wchscu.edu.cn

Keywords：

Intraocular lens; axial length; tilt; decentration; high myopia

DOI：

10.7507/1002-0179.202501146

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the influencing factors of intraocular lens (IOL) position after cataract surgery and analyze the effect of ocular biological parameters on IOL centering under different axial length (AL). Methods Patients who underwent cataract phacoemulsification and IOL implantation at West China Hospital of Sichuan University between February and July 2024 were prospectively selected. According to the different AL values, the patients were divided into non-high myopia group (22.0 mm≤AL＜26.0 mm) and high myopia group (AL≥26.0 mm) to explore the influencing factors of IOL position after cataract surgery. Results This study included a total of 240 patients (240 eyes), with 120 cases (120 eyes) in both the non-high myopia group and the high myopia group. The preoperative lens tilt and decentration of the non-high myopia group and high myopia group were (4.41±1.07)°, (0.13±0.09) mm and (3.57±1.81)°, (0.20±0.10) mm, respectively. The results of multiple linear regression analysis showed that in the non-high myopia group, preoperative lens tilt (P<0.001) was the influencing factor of postoperative IOL tilt, while lens thickness (P=0.027) and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. In the high myopia group, lens thickness (P=0.023) and preoperative lens tilt (P<0.001) were the influencing factors of postoperative IOL tilt, while anterior chamber depth (P=0.030), lens thickness (P=0.013), and preoperative lens decentration (P<0.001) were the influencing factors of postoperative IOL decentration. Conclusion Ophthalmologists can accurately predict the postoperative IOL position based on the patient’s degree of myopia (with a focus on identifying high myopia) and specific ocular biological parameters before surgery, thereby optimizing surgical plans and improving postoperative outcomes.

Citation： XU Feng, MU Jiancheng, YANG Ning, GUO Wanyue, SUN Chuhuan, PENG Bosen, FAN Wei. Study on influencing factors of intraocular lens position after cataract surgery. West China Medical Journal, 2025, 40(6): 937-943. doi: 10.7507/1002-0179.202501146 Copy

1.	Roop, Roop P. Optimizing optical outcomes of intraocular lens implantation by achieving centration on visual axis. Indian J Ophthalmol, 2017, 65(12): 1425-1427.
2.	Lawu T, Mukai K, Matsushima H, et al. Effects of decentration and tilt on the optical performance of 6 aspheric intraocular lens designs in a model eye. J Cataract Refract Surg, 2019, 45(5): 662-668.
3.	Ale JB. Intraocular lens tilt and decentration: a concern for contemporary IOL designs. Nepal J Ophthalmol, 2011, 3(1): 68-77.
4.	Xu J, Zheng T, Lu Y. Effect of decentration on the optical quality of monofocal, extended depth of focus, and bifocal intraocular lenses. J Refract Surg, 2019, 35(8): 484-492.
5.	Hayashi K, Hayashi H. Comparison of the stability of 1-piece and 3-piece acrylic intraocular lenses in the lens capsule. J Cataract Refract Surg, 2005, 31(2): 337-342.
6.	Zhu X, He W, Zhang Y, et al. Inferior Decentration of multifocal intraocular lenses in myopic eyes. Am J Ophthalmol, 2018, 188: 1-8.
7.	Wu YF, Tu RX, Zhang Y, et al. Influence of ocular biometric parameters on intraocular lens position: a prospective cohort study. J Refract Surg, 2024, 40(7): e438-e444.
8.	Chang PY, Lian CY, Wang JK, et al. Surgical approach affects intraocular lens decentration. J Formos Med Assoc, 2017, 116(3): 177-184.
9.	Wang L, Guimaraes de Souza R, Weikert MP, et al. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg, 2019, 45(1): 35-40.
10.	Lu Q, He W, Qian D, et al. Measurement of crystalline lens tilt in high myopic eyes before cataract surgery using swept-source optical coherence tomography. Eye Vis (Lond), 2020, 7: 14.
11.	Cheng H, Wang L, Kane JX, et al. Accuracy of artificial intelligence formulas and axial length adjustments for highly myopic eyes. Am J Ophthalmol, 2021, 223: 100-107.
12.	Chen X, Gu X, Wang W, et al. Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg, 2020, 46(8): 1126-1131.
13.	Holladay JT, Piers PA, Koranyi G, et al. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. J Refract Surg, 2002, 18(6): 683-691.
14.	Borkenstein AF, Borkenstein EM, Luedtke H, et al. Impact of decentration and tilt on spherical, aberration correcting, and specific aspherical intraocular lenses: an optical bench analysis. Ophthalmic Res, 2022, 65(4): 425-436.
15.	Kimura S, Morizane Y, Shiode Y, et al. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS One, 2017, 12(9): e0184066.
16.	Wang L, Jin G, Zhang J, et al. Clinically significant intraocular lens decentration and tilt in highly myopic eyes: a swept-source optical coherence tomography study. Am J Ophthalmol, 2022, 235: 46-55.
17.	Jeon YY, Park N, Lee H, et al. Analysis of intraocular lens tilt and decentration after cataract surgery in eyes with high myopia using the anterior segment optical coherence tomography. Sci Rep, 2024, 14(1): 27987.
18.	Wang L, Cao D, Weikert MP, et al. Calculation of axial length using a single group refractive index versus using different refractive indices for each ocular segment: theoretical study and refractive outcomes. Ophthalmology, 2019, 126(5): 663-670.
19.	Ozates S, Kiziltoprak H, Koc M, et al. Intraocular lens position in combined phacoemulsification and vitreoretinal surgery. Retina, 2018, 38(11): 2207-2213.
20.	Feng L, Vidal CC, Weeber H, et al. Effects of capsulorhexis size and position on post-surgical IOL alignment. Sci Rep, 2024, 14(1): 31132.
21.	Sato T, Shibata S, Yoshida M, et al. Short-term dynamics after single- and three-piece acrylic intraocular lens implantation: a swept-source anterior segment optical coherence tomography study. Sci Rep, 2018, 8(1): 10230.
22.	Gangwani V, Hirnschall N, Koshy J, et al. Posterior capsule opacification and capsular bag performance of a microincision intraocular lens. J Cataract Refract Surg, 2011, 37(11): 1988-1992.
23.	方艳文, 卢奕, 汪琳. 折叠式人工晶状体囊袋内植入后偏心与倾斜的临床研究. 眼视光学杂志, 2008, 10(4): 252-255, 258.
24.	Modesti M, Pasqualitto G, Appolloni R, et al. Preoperative and postoperative size and movements of the lens capsular bag: ultrasound biomicroscopy analysis. J Cataract Refract Surg, 2011, 37(10): 1775-1784.
25.	Chen Y, Meng J, Cheng K, et al. Influence of IOL weight on long-term iol stability in highly myopic eyes. Front Med (Lausanne), 2022, 9: 835475.
26.	Bozukova D, Werner L, Mamalis N, et al. Double-C loop platform in combination with hydrophobic and hydrophilic acrylic intraocular lens materials. J Cataract Refract Surg, 2015, 41(7): 1490-1502.
27.	Meng J, He W, Rong X, et al. Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes. Eye Vis (Lond), 2020, 7: 17.
28.	Rossi T, Ceccacci A, Testa G, et al. Influence of anterior capsulorhexis shape, centration, size, and location on intraocular lens position: finite element model. J Cataract Refract Surg, 2022, 48(2): 222-229.

1. Roop, Roop P. Optimizing optical outcomes of intraocular lens implantation by achieving centration on visual axis. Indian J Ophthalmol, 2017, 65(12): 1425-1427.
2. Lawu T, Mukai K, Matsushima H, et al. Effects of decentration and tilt on the optical performance of 6 aspheric intraocular lens designs in a model eye. J Cataract Refract Surg, 2019, 45(5): 662-668.
3. Ale JB. Intraocular lens tilt and decentration: a concern for contemporary IOL designs. Nepal J Ophthalmol, 2011, 3(1): 68-77.
4. Xu J, Zheng T, Lu Y. Effect of decentration on the optical quality of monofocal, extended depth of focus, and bifocal intraocular lenses. J Refract Surg, 2019, 35(8): 484-492.
5. Hayashi K, Hayashi H. Comparison of the stability of 1-piece and 3-piece acrylic intraocular lenses in the lens capsule. J Cataract Refract Surg, 2005, 31(2): 337-342.
6. Zhu X, He W, Zhang Y, et al. Inferior Decentration of multifocal intraocular lenses in myopic eyes. Am J Ophthalmol, 2018, 188: 1-8.
7. Wu YF, Tu RX, Zhang Y, et al. Influence of ocular biometric parameters on intraocular lens position: a prospective cohort study. J Refract Surg, 2024, 40(7): e438-e444.
8. Chang PY, Lian CY, Wang JK, et al. Surgical approach affects intraocular lens decentration. J Formos Med Assoc, 2017, 116(3): 177-184.
9. Wang L, Guimaraes de Souza R, Weikert MP, et al. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg, 2019, 45(1): 35-40.
10. Lu Q, He W, Qian D, et al. Measurement of crystalline lens tilt in high myopic eyes before cataract surgery using swept-source optical coherence tomography. Eye Vis (Lond), 2020, 7: 14.
11. Cheng H, Wang L, Kane JX, et al. Accuracy of artificial intelligence formulas and axial length adjustments for highly myopic eyes. Am J Ophthalmol, 2021, 223: 100-107.
12. Chen X, Gu X, Wang W, et al. Characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg, 2020, 46(8): 1126-1131.
13. Holladay JT, Piers PA, Koranyi G, et al. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. J Refract Surg, 2002, 18(6): 683-691.
14. Borkenstein AF, Borkenstein EM, Luedtke H, et al. Impact of decentration and tilt on spherical, aberration correcting, and specific aspherical intraocular lenses: an optical bench analysis. Ophthalmic Res, 2022, 65(4): 425-436.
15. Kimura S, Morizane Y, Shiode Y, et al. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS One, 2017, 12(9): e0184066.
16. Wang L, Jin G, Zhang J, et al. Clinically significant intraocular lens decentration and tilt in highly myopic eyes: a swept-source optical coherence tomography study. Am J Ophthalmol, 2022, 235: 46-55.
17. Jeon YY, Park N, Lee H, et al. Analysis of intraocular lens tilt and decentration after cataract surgery in eyes with high myopia using the anterior segment optical coherence tomography. Sci Rep, 2024, 14(1): 27987.
18. Wang L, Cao D, Weikert MP, et al. Calculation of axial length using a single group refractive index versus using different refractive indices for each ocular segment: theoretical study and refractive outcomes. Ophthalmology, 2019, 126(5): 663-670.
19. Ozates S, Kiziltoprak H, Koc M, et al. Intraocular lens position in combined phacoemulsification and vitreoretinal surgery. Retina, 2018, 38(11): 2207-2213.
20. Feng L, Vidal CC, Weeber H, et al. Effects of capsulorhexis size and position on post-surgical IOL alignment. Sci Rep, 2024, 14(1): 31132.
21. Sato T, Shibata S, Yoshida M, et al. Short-term dynamics after single- and three-piece acrylic intraocular lens implantation: a swept-source anterior segment optical coherence tomography study. Sci Rep, 2018, 8(1): 10230.
22. Gangwani V, Hirnschall N, Koshy J, et al. Posterior capsule opacification and capsular bag performance of a microincision intraocular lens. J Cataract Refract Surg, 2011, 37(11): 1988-1992.
23. 方艳文, 卢奕, 汪琳. 折叠式人工晶状体囊袋内植入后偏心与倾斜的临床研究. 眼视光学杂志, 2008, 10(4): 252-255, 258.
24. Modesti M, Pasqualitto G, Appolloni R, et al. Preoperative and postoperative size and movements of the lens capsular bag: ultrasound biomicroscopy analysis. J Cataract Refract Surg, 2011, 37(10): 1775-1784.
25. Chen Y, Meng J, Cheng K, et al. Influence of IOL weight on long-term iol stability in highly myopic eyes. Front Med (Lausanne), 2022, 9: 835475.
26. Bozukova D, Werner L, Mamalis N, et al. Double-C loop platform in combination with hydrophobic and hydrophilic acrylic intraocular lens materials. J Cataract Refract Surg, 2015, 41(7): 1490-1502.
27. Meng J, He W, Rong X, et al. Decentration and tilt of plate-haptic multifocal intraocular lenses in myopic eyes. Eye Vis (Lond), 2020, 7: 17.
28. Rossi T, Ceccacci A, Testa G, et al. Influence of anterior capsulorhexis shape, centration, size, and location on intraocular lens position: finite element model. J Cataract Refract Surg, 2022, 48(2): 222-229.

West China Medical Journal

Study on influencing factors of intraocular lens position after cataract surgery

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