OBJECTIVE: To present a new method of dynamic Purkinje-metry and to verify it by comparison with a commercially available anterior segment optical coherence tomography CASIA2.
METHODS: A dynamic Purkinje-meter with a movable fixation target was assembled. A coaxial circular pattern formed by infrared LEDs was projected onto the eye and evoked Purkinje images (1st, 3rd, 4th = P1, P3, P4). The measurement was performed on 29 eyes with an implanted toric IOL (intraocular lens), under mydriatic conditions, with reference to the visual axis. The IOL tilt was calculated from the position of a fixation target at the moment of P3 and P4 superposition. The IOL decentration was determined based on the relative position of P1 during on-axis fixation and of P3 and P4 superposition during off-axis fixation. A custom-developed software was used for distance measurements. Using CASIA2, the IOL position was fully calculated by the device.
RESULTS: The mean absolute difference between CASIA2 and Purkinje-meter values was 0.6° ± 0.4° for the tilt magnitude and 10° ± 10° for the tilt direction, and 0.11 mm ± 0.08 mm for the decentration magnitude and 16° ± 14° for the decentration direction. There was no statistically significant difference between the values determined by the two methods for the tilt and decentration direction. The differences were statistically significant for the tilt and decentration magnitude.
CONCLUSIONS: The values of IOL tilt and decentration direction are similar for both devices. The values of IOL tilt and decentration magnitude measured by Purkinje-meter are higher than those from CASIA2, but overall, they correspond to the values presented in other published studies.

UNASSIGNED: To evaluate and compare the magnitude of intraocular lens (IOL) decentration and tilt following conventional and femtosecond laser-assisted cataract surgery (FLACS) using swept-source anterior optical coherence tomography (SS-OCT).
UNASSIGNED: In this retrospective observational study, we enrolled patients who underwent conventional cataract surgery or FLACS with the implantation of hydrophobic 1-piece monofocal IOL. The magnitude of IOL decentration and tilt were measured using SS-OCT. Visual acuity, intraocular pressure, spherical equivalent, axial length, contrast sensitivity, and satisfaction questionnaire were evaluated before and one-month post-surgery. Additionally, postoperative internal cylinder measurements were obtained using a wavefront aberrometer. Correlation factors between each parameter and IOL decentration or tilt were analyzed.
UNASSIGNED: This study included 100 eyes from 100 patients. Mean IOL decentration and tilt were 0.21 ± 0.13 mm and 5.01 ± 1.49°, respectively. Conventional cataract surgery (versus FLACS, P = 0.001) and male sex (versus female, P = 0.047) were significantly correlated with higher postoperative decentration. Preoperative lens diameter (P < 0.001), preoperative lens tilt (P = 0.007), and preoperative intraocular pressure (P = 0.027) were correlated with higher postoperative tilt. Fifty eyes that underwent FLACS demonstrated mean postoperative decentration of 0.21 ± 0.13 mm and tilt of 4.64 ± 1.48°. Compared with the conventional surgery group, the FLACS group significantly differed in postoperative decentration (0.30 ± 0.12 mm, P < 0.001) but not in tilt (5.03 ± 1.35°, P = 0.173). Postoperative visual acuity did not significantly differ between the two groups.
UNASSIGNED: Patients who underwent FLACS demonstrated better IOL decentration and tilt than those who underwent conventional cataract surgery one-month post-surgery. However, differences in IOL decentration and tilt did not affect postoperative visual acuity.

OBJECTIVE: To investigate the effect of Cionni-modified capsular tension ring (CTR) implantation in patients with severely traumatic subluxated cataracts.
METHODS: All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed. Corrected distance visual acuity (CDVA), extent of zonulysis, intraocular lens (IOL) position, intraoperative presentation, and complications were assessed. The primary outcomes included IOL centration stability and other postoperative complications.
RESULTS: Twenty patients (20 eyes) were included in this study. The mean age in this study was 58.0±11.3y, and the average follow-up time was 17.3±12.8mo. Capsule bags were saved by Cionni-modified CTR. Nine eyes (45%) underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber. The preoperative mean CDVA was 0.83±0.24 logMAR, and the postoperative average CDVA was 0.23±0.30 logMAR (P<0.05). The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm, respectively; the vertical and horizontal IOL tilt after surgery was 5.5°±2.5° and 6.1°±2.2°, respectively. None of the eyes had obvious IOL decentration during the follow-up time. Eight eyes (40%) had posterior capsule opacification (PCO) that was severe enough to cause poor vision. Neodymium: YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.
CONCLUSIONS: With the help of Cionni-modified CTR, capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

A 68-year-old female underwent a full-thickness penetrating keratoplasty (PK) and developed a mature cataract for which she was operated on using the phacoemulsification technique with the implantation of polymethyl methacrylate lens. The patient developed diminished vision one month after the cataract surgery. The patient had a contraction of the anterior capsular opening. Neodymium-doped yttrium aluminum garnet laser (ND:YAG) anterior capsulotomy was performed to create an opening in the anterior capsule, following which the patient regained her vision. To the best of our knowledge, this is the first report of early anterior capsular contraction in a patient operated for PK.

BACKGROUND: To evaluate long-term intraocular lens (IOL) decentration and tilt in eyes with pseudoexfoliation syndrome (PES) following cataract surgery using Visante anterior segment OCT and iTrace Visual Function Analyzer.
METHODS: Sixty-four eyes following cataract surgery from 2009 to 2012 were included, 34 eyes had PES and 30 eyes did not show PES. A standard phacoemulsification procedure followed by IOL implantation was performed and patients were followed 4-6 years after surgery (mean = 69 months). Best-corrected visual acuity (BCVA), capsulorhexis size, and intraocular pressure (IOP) were measured. IOL decentration and IOL tilt were evaluated using Visante Omni anterior segment OCT (Carl Zeiss Jena GmBH, Germany). The iTrace VFA (Visual Function Analyzer, Hoya surgical optics) was used to measure corneal, internal, and total optical aberrations.
RESULTS: Measurements with iTrace showed that horizontal coma was significantly different between PES and control eyes (p = 0.037). Horizontal as well as vertical tilt showed a significant difference between PES and control eyes (p = 0.035 and p = 0.039). Tilt correlated with capsulorhexis size in PES patients (p = 0.011). This indicates a forward tilt of the superior edge of the IOL in eyes with PES.
CONCLUSIONS: Patients affected by PES seem to have a higher risk for long-term complications and changes in visual perception due to IOL tilt and decentration after cataract surgery.

OBJECTIVE: To assess the effect of posterior capsular opacification (PCO) and Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy on tilt and decentration of intraocular lens (IOL) at vertical and horizontal meridians.
METHODS: The study included 64 eyes of 64 patients. IOL decentration and tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Corrected distance visual acuity (CDVA) and manifest refraction were also determined. Between-group differences of IOL position change and the effect of Nd:YAG laser capsulotomy were analyzed.
RESULTS: In the PCO group, before capsulotomy, CDVA was significantly lower than that after capsulotomy and of the control group values (p = 0.001 for both). No significant difference was observed in CDVA between the control group and the PCO group after capsulotomy (p = 0.854). Before capsulotomy, the angle of tilt and decentration at both meridians was significantly higher than that in the control group (tilt: p < 0.001; for both decentrations: p = 0.001, p = 0.003, respectively). A significant decrease was observed in the angle of tilt at both meridians (horizontal p = 0.001, vertical p = 0.001) from before to after capsulotomy in the PCO group. Although decentration was increased after capsulotomy, no significant position change was observed (horizontal p = 0.350, vertical p = 0.107). The angle of tilt and decentration at both meridians was significantly higher in the PCO group after capsulotomy compared to the control group (p < 0.001 for all).
CONCLUSIONS: PCO is associated with not only axial displacement, but also tilt and decentration of IOL at the vertical and horizontal meridians. Laser capsulotomy decreased IOL tilt but had no effect on decentration. However, these changes did not significantly change the visual acuity between the control group and the PCO group after capsulotomy.

OBJECTIVE: The purpose of this study is to describe a new technique for small-incision scleral fixation of intraocular lens (IOL) using double 10-0 polypropylene sutures, and to report the outcomes of IOL position compared with intrascleral IOL fixation at 12-month follow-up.
METHODS: A retrospective comparative study.
METHODS: This new technique, called double sutured scleral fixated-IOL (DSF-IOL), was created to help with long-term knots strengthening by applying double sutures to each IOL haptic using an augmented Clove-hitch knot instead of the conventional knots tied by single suture. The tilt and decenter of IOL were measured by Scheimpflug camera and other refractive outcomes were compared between two groups at 12-month follow-up.
RESULTS: This study consisted of 26 eyes (54.2%) from the DSF-IOL group, and 22 eyes (45.8%) from the intrascleral fixated IOL (ISF-IOL) group. No significant differences of mean absolute degree of IOL tilt (2.90 ± 0.77 vs 2.82 ± 0.72; p = 0.633) and IOL decenter (151.90 ± 59.80 vs 175.0 ± 73.14 microns; p = 0.265) were found between the two groups. Post-operative LogMAR visual acuity was not statistically different between the two groups (0.32 ± 0.17 vs 0.41 ± 0.19, p = 0.089). Early post-operative hypotony was only present in the ISF-IOL group (13.6%).
CONCLUSIONS: This study shows that DSF-IOL is as effective as ISF-IOL. This technique can be a simpler approach to optimize small-incision scleral fixation of IOL without the complications associated with intrascleral IOL fixation.

OBJECTIVE: This study aims to quantify and identify risk factors for intraocular lens (IOL) tilt and decentration early after surgery using Scheimpflug imaging.
METHODS: We prospectively included 268 eyes of 253 patients who underwent uneventful cataract surgery and one-piece IOL implantation using a superior or temporal approach. Scheimpflug imaging was used to evaluate the tilt and decentration of IOLs at 1 week, 1 month, and 3 months postoperatively. Differences in IOL tilt and decentration between the approaches were examined. Correlations of age and axial length with the magnitudes of IOL decentration and tilt were also examined.
RESULTS: In total, 139 right and 129 left eyes were included. IOL displacement averaged 150 μm upward and 150 μm to the nasal side of the pupil. Over 50% of the eyes were tilted upward and approximately 90% to the temporal side. The surgical approach was significantly associated with horizontal decentration in both eyes, but significantly associated with only vertical decentration in the right eye 1 week postoperatively. In the left eyes, IOLs were shifted to the nasal side in 57.1% and 36.8% of the eyes that received the temporal and the superior approach, respectively, compared with 75.8% and 50% in the right eyes. The differences were significant only at 1-week follow-up (p = 0.035 and p = 0.003, respectively). Age or axial length was not associated with IOL tilt or decentration in either eye.
CONCLUSIONS: Scheimpflug imaging can be used as a quantitative tool to evaluate IOL position. The incision site affected the IOL position, this finding was significant at 1 week postoperatively only.