Risk Factor Analysis For Post-Operative Intraocular Lens Tilt After Sutureless Scleral Fixated Intraocular Lens Implantation

Detection and quantification of risk factors for post-operative intraocular lens (IOL) tilt after sutureless scleral fixated IOL implantation

Ophthalmology department, Kepler University Clinic, and Johannes Kepler University, Linz, Austria

Patients who underwent sutureless scleral fixated IOL implantation between 2018 and 2024 were included in this non-randomised study. In all cases the Yamane technique (either ZA9003, Johnson&Johnson, USA or PU6A, KOWA, Japan) or a sleral self-anchoring haptic IOL (Carlevale, FIL-SSF) was used. Study examinations were performed one day and two months after surgery. Study examinations included optical biometry (IOLMaster700, Carl Zeiss Meditec AG, Germany), corneal tomography including tilt measurement (Casia2, Tomey Corp, Japan and MS-39, CSO, Italy) and a wavefront analysis (Osiris, CSO, Italy) autorefraction, subjective refraction and corrected as well as uncorrected visual acuity.

In total 75 patients were enrolled in this study. Mean tilt and mean decentration was found to be 5.42° (SD: ±1.73°) and 0.51 mm (SD: ±0.39), respectively. Mean axial eye length was 24.25 mm (SD: ±1.2) and mean anterior chamber depth 4.82 mm (SD: ±0.41). Neither surgical technique nor axial eye length was found to be a significant risk factor for post-operative decentration. An increased risk was found for a deep anterior chamber depth,  but preliminary results did not reach significance.

Post-operative IOL tilt is more common after sutureless scleral fixated intraocular lens implantation compared to in the bag IOL implantation. Risk factor stratification was found to be difficult due to a large inter-patient deviation. A deep anterior chamber depth was found to be a relevant risk factor. A larger sample size will be presented at the ESCRS meeting.