Intraocular Lens Tilt And Decentration And Optical Quality After Primary Intraocular Lens Implantation In Pediatric Cataract Patients

To investigate the characteristics and associated factors of intraocular lens (IOL) tilt and decentration in pediatric cataract patients undergoing primary IOL implantation and to explore their impact on postoperative optical quality.

Eye Hospital of Wenzhou Medical University (Hangzhou Branch)

Children who underwent cataract extraction with posterior capsulotomy, primary anterior vitrectomy, and in-the-bag IOL implantation over 6 months were enrolled. Patient data and ocular biometric parameters were retrieved from electronic files. Retroillumination images were obtained to evaluate capsular outcomes. IOL tilt and decentration were assessed using the swept-source optical coherence tomography, and wavefront aberrations were measured with the OPD-Scan III.

A total of 125 eyes from 125 patients with a mean age at surgery of 4.74 ± 1.49 years were included. The IOLs demonstrated a mean tilt of 6.02 ± 1.97 degrees and a mean decentration of 0.28 ± 0.13 mm. Multivariate analysis revealed that shorter axial length (AL; P = 0.009) and significant cortical proliferation (P = 0.021) were associated with greater IOL tilt. In addition, smaller corneal diameter (CD; P = 0.008) and incomplete capsulorhexis-IOL overlap (P = 0.022) were associated with larger IOL decentration. Patients with IOL tilt ≥ 7 degrees and decentration ≥ 0.40 mm exhibited higher internal total higher-order aberrations (tHOA) and internal astigmatism, both of which were positively correlated with IOL misalignment (all P < 0.05).

Shorter AL, smaller CD, significant cortical proliferation, and incomplete capsulorhexis-IOL overlap contributed to greater IOL misalignment in pediatric cataract patients with primary in-the-bag IOL implantation, which may compromise postoperative optical quality by increasing internal tHOA and astigmatism.