Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

Doo Ri Eo; Dong Hui Lim; Joo Hyun; Ju Yeon Lee; Han Woong Lim; Jae Eung Oh; Eui Sang Chung; Tae Young Chung

doi:10.3341/jkos.2016.57.4.575

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Eo, Lim, Hyun, Lee, Lim, Oh, Chung, and Chung: Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

Original Article

J Korean Ophthalmol Soc 2016;57(4):575-581.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.575

Effects of Continuous Curvilinear Capsulorhexis, Intraocular Lens Decentration and Tilt on Clinical Outcomes

Doo Ri Eo, MD¹, Dong Hui Lim, MD¹, Joo Hyun, MD¹, Ju Yeon Lee, MD¹, Han Woong Lim, MD², Jae Eung Oh, PhD³, Eui Sang Chung, MD, PhD¹, Tae Young Chung, MD, PhD^1,

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Ophthalmology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea

³Division of Mechanical Engineering Hanyang University School of Mechanical Engineering, Seoul, Korea

Address reprint requests to Tae Young Chung, MD, PhD Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: 82-2-3410-3563, Fax: 82-2-3410-0074 E-mail: tychung@skku.edu

Received 3 December 2015 Revised 12 January 2016 Accepted 8 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effects of continuous curvilinear capsulorhexis, intraocular lens (IOL) decentration and tilt on postoperative clinical outcomes after cataract surgery.

Methods

We reviewed 62 eyes of 52 patients who underwent cataract surgery and measured the uncorrected visual acuity, best corrected visual acuity and manifest refraction preoperatively and 3 months postoperatively. IOL decentration on anterior segment photography and IOL tilt on anterior optical coherent tomography were analyzed and correlations of postoperative uncorrected visual acuity, best corrected visual acuity, and higher order aberrations were evaluated. In addition, we inspected the relationship of size and decentration of continuous curvilinear capsulorhexis (CCC) intraoperatively with the change in IOL position postoperatively.

Results

The average size of CCC was 5.40 ± 0.51 mm (4.12-6.24 mm) and the average decentration of CCC was 0.30 ± 0.19 mm (0.09-1.21 mm) intraoperatively. The average decentration of IOL was 0.23 ± 0.15 mm (0.00-0.71 mm) and the average IOL tilt was 1.43 ± 0.73° (0.00-4.22°) postoperatively. Intraoperative CCC size and decentration were associated with postoperative IOL decentration (p = 0.01, p < 0.001), but not with IOL tilt (p = 0.69, p = 0.52). There were no significant correlations between IOL decentration and tilt with postoperative visual outcomes and higher order aberrations.

Conclusions

The CCC size and decentration can affect the IOL decentration, but IOL decentration and tilt do not have a significant impact on clinical outcomes after cataract surgery.

Keywords: Continuous curvilinear capsulorhexis, Decentration, Higher-order aberrations, Intraocular lens, Tilt

References

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Figure 1.

Anterior segment photography. Measurements of CCC size and decentration from the dilated pupil center in the intraoperative state (A) and IOL decantation in the postoperative state (B). CCC = continuous circular capsulorhexis; IOL = intraocular lens.

Figure 2.

Measurement of IOL tilt angle in the x-axis (α‘) and y-axis (β‘) from the line connecting both scleral spurs using anterior segment OCT (Visante™ OCT). IOL = intraocular lens; OCT = optical coherence tomography.

Figure 3.

Schematic images of calculation of intraocular lens tilt direction from visual axis. IOL = intraocular lens.

Figure 4.

Plots of correlation of CCC with IOL. CCC size and IOL decentration (A), CCC size and IOL tilt (B), CCC decentration and IOL decentration (C), CCC decentration and IOL tilt (D). r² = coefficient of determination; CCC = continuous curvilinear capsulorhexis; IOL = intraocular lens.

Table 1.

Patient characteristics

Demographics	Mean ± SD	Min, Max
Age (years)	64.71 ± 10.98	38, 86
Gender (male:female)	24:28
Duration of follow-up (days)	97.03 ± 5.41	88, 116
Preoperative UCVA (decimal)	0.46 ± 0.34	0.01, 1.00
Preoperative BCVA (decimal)	0.56 ± 0.29	0.05, 1.00
Preoperative MRSE (D)	−1.02 ± 3.55	−10.75, +3.13
Preoperative cylinder (D)	−0.79 ± 0.62	−2.50, 0.00

Values are presented as mean ± SD unless other wise indicated. SD = standard deviation; Min = minimum; Max = maximum; UCVA = uncorrected visual acuity; BCVA = best-corrected visual acuity; MRSE = manifest refraction spherical equivalent; D = diopter.

Table 2.

Parameters of continuous curvilinear capsulorhexis and intraocular lens

Parameters	Mean ± SD	Min, Max
CCC size (mm)	5.40 ± 0.51	4.12, 6.24
CCC decentration (mm)	0.30 ± 0.19	0.09, 1.21
IOL decentration (mm)	0.23 ± 0.15	0.00, 0.71
IOL tilt (°)	1.43 ± 0.73	0.00, 4.22

Values are presented as mean ± SD unless otherwise indicated. SD = standard deviation; Min = minimum; Max = maximum, CCC = continuous curvilinear capsulorhexis; IOL = intraocular lens.

Table 3.

Postoperative clinical outcomes and p-value of linear regression between intraocular lens position and postoperative clinical outcomes

	Mean ± SD	Min, Max	p-value^*	p-value^†
Postoperative UCVA (decimal)	0.77 ± 0.26	0.10, 1.00	0.46	0.14
Postoperative BCVA (decimal)	0.95 ± 0.12	0.50, 1.00	0.65	0.85
Postoperative MRSE (D, emme target)	−0.17 ± 0.51	−1.75, 0.50	0.21	0.27
Postoperative MRSE (D, near target)	−2.56 ± 1.10	−4.00, −0.25	0.17	0.21
Postoperative cylinder (D)	−0.61 ± 0.47	−2.00, 0.00	0.34	0.07
Coma (micron)	0.46 ± 0.38	0.08, 2.07	0.35	0.87
Trefoil (micron)	0.51 ± 0.33	0.07, 2.01	0.15	0.72
HoA (micron)	0.30 ± 0.16	0.08, 0.92	0.43	0.58
SA (micron)	0.25 ± 0.19	0.02, 1.40	0.71	0.88

Values are presented as mean ± SD unless otherwise indicated.

SD = standard deviation; Min = minimum; Max = maximum; UCVA = uncorrected visual acuity; BCVA = best-corrected visual acuity; MRSE = manifest refraction spherical equivalent; D = diopter; HoA = high-order aberration; SA = spherical aberration.

^* p-value of simple linear regression between intraocular lens decentration and postoperative clinical outcomes;

^† p-value of simple linear regression between intraocular lens tilt and postoperative clinical outcomes.

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