Comparison Of Decentration And The Evaluation Of Possible Correlation Between Decentration, Preoperative Characteristics, And Visual Outcomes Following The Implantation Of Three Different Presbyopia-Correcting Intraocular Lens Models

Presbyopia-correcting intraocular lenses (IOLs) meet the expectations of several cataract patients, however, patient selection is fundamental to obtaining the desired and best possible clinical outcomes. Preoperative anatomical characteristics might have an impact on the future position of the IOL in the eye, which in the case of diffractive optics might influence visual outcomes. The current investigation compares the probability, extent, and direction of decentration after the implantation of three different trifocal IOL models, and attempts to find correlations between IOL decentration, biometric parameters, and future visual outcomes.

Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P., Mexico City, Mexico.

Three different IOL models were implanted mono- or binocularly (Liberty 677MY with double-loop haptics: 11 patients/20 eyes; PanOptix with C-loop haptics: 17 patients/33 eyes; AT LISA tri with plate haptics: 10 patients/20 eyes). Mono- and binocular visual acuities (VAs) were measured 6 months postoperatively. Uncorrected visual acuity defocus curves were plotted, and the area under curves (AUC) were calculated in each case. Each IOL was examined to define the extent and direction of decentration. Correlations between IOL decentration and preoperative and postoperative anterior chamber depth, axial length, white-to-white, and postoperative VAs at multiple distances were tested in each IOL-group, and also in the overall patient population.

Although similar decentration values could be observed with all three IOLs, the PanOptix lens is more prone to move in a temporal direction, while the Liberty and the AT LISA lenses are equally likely to be located in a slightly temporal or nasal position. Regardless of the optic and haptic design, both temporal and nasal decentration leads to a significant decrease in intermediate and near vision, with a larger impact in the case of nasal decentration. No correlation between decentration and any of the examined preoperative values or IOL thickness could be found.

The three examined parameters (axial length, white-to-white, anterior chamber depth) were not correlated with a higher extent of IOL decentration.  Based on these characteristics, preoperative patient selection cannot be performed to avoid future IOL decentration. Nasal decentration has a higher negative impact on intermediate and near visual acuity, than temporal.