Impact Of Eyeball Configuration On Intraocular Lens Tilt And Decentration With Predictive Model Construction

To statistically analyze the AS-OCT parameters of patients with varying anterior segment sizes and axial lengths, and to construct predictive models to evaluate postoperative tilt and decentration of intraocular lenses (IOLs).

Advancements in cataract surgery prioritize visual quality, which is highly dependent on precise IOL positioning. Tilt >5° or decentration >0.4 mm induces optical aberrations and reduces contrast sensitivity, with severe effects for multifocal/toric IOLs. The influence of axial length on this stability is debated. 

156 eyes were included in this study. The parameters included AL, WTW, preoperative lens tilt and decentration, ACD, LT, and the tilt and decentration of IOLs one month postoperatively. Patients were divided into large anterior segment and small anterior segment groups based on the ratio of lens position to AL. Differences in parameters between the two groups were compared, as well as the incidence of significant tilt greater than 5° and decentration greater than 3mm postoperatively. Additionally, the proportion of large anterior segments and small anterior segments in different axial length groups was compared. Logistic regression was utilized to construct a predictive model for the risk of significant tilt occurring postoperatively.

Significant differences were observed between the two groups in terms of AL, ACD, postoperative IOL tilt, and postoperative visual acuity. The large anterior segment group exhibited a significantly greater degree of postoperative IOL tilt compared to the small anterior segment group, and the incidence of significant tilt and decentration was higher in the large anterior segment group. Among the short axial length group, the proportion of large anterior segments was the highest compared to other groups. Regression analysis indicated that preoperative IOL tilt was an independent risk factor for postoperative tilt, and the constructed risk prediction model demonstrated good predictive performance and clinical utility.

This study provides new insights into the influence of different ocular configurations on the tilt and decentration of IOLs after cataract surgery, offering guidance for surgical design and the selection of IOL types.