16 As far as we known, there are no published reports regarding IOL tilt and decentration of phacoemulsification in patients with prior PPV. 16 – 18 The possible explanation for the variable results is that the air tamponade may induce greater IOL position abnormality in cases with large continuous curvilinear capsulorhexis (CCC) than those with small CCC. 14, 15 Few studies have assessed the impact of intravitreal tamponades (IVTs) on IOL tilt and decentration of combined phacoemulsification-vitrectomy, but the conclusions were inconsistent. 5 Previous studies have reported the increased IOL tilt and decentration in special populations, such as patients with pseudoexfoliation syndrome or undergoing IOL scleral-suturing. 13 However, greater IOL tilt and decentration could cause defocus, astigmatism, and coma-like aberration, leading to the deterioration of visual function. A certain degree of IOL tilt and decentration occur after cataract surgery, most of which are clinically tolerant. 12 Therefore, it is imperative to investigate the characteristics and the risk factors of IOL tilt and decentration in patients with prior PPV.Įxact positioning and alignment of the IOL with the visual axis are the prerequisites of high-quality visual performance after cataract surgery. 7 – 11 Furthermore, optical quality of aspheric IOL even decreased below that of conventional spherical IOL when decentration was greater than 0.4 mm and tilt was more than 7 degrees. 5, 6 It has been reported that visual performance of multifocal and toric IOLs was profoundly affected by decentration and tilt. 3, 4 However, optically sophisticated designed IOLs are more sensitive to tilt and decentration compared with conventional IOLs. 1, 2 As PPVs have achieved high anatomic success rates and satisfactory functional outcomes due to the improved vitreoretinal surgical techniques, more and more surgeons attempt to use the sophisticated designed intraocular lens (IOL), such as aspheric, multifocal, and astigmatism correcting IOLs in vitrectomized eyes. Optically sophisticated designed IOLs should be used cautiously in vitrectomized eyes.Ĭataract formation is the most common postoperative complication of pars plana vitrectomy (PPV). Longer duration of SO tamponade, hydrophilic IOL, as well as DM were the risk factors of greater IOL tilt and decentration in patients with prior PPV. Patients with prior vitrectomy had greater IOL tilt and decentration than the non-PPV group. The internal total higher-order aberration, coma, trefoil, and secondary astigmatism in the PPV group were higher than in the non-PPV group, and positively correlated with IOL tilt ( P < 0.05). Duration of SO tamponade was positively correlated with IOL tilt ( P = 0.014) and decentration ( P < 0.001). Multiple logistic regression showed that silicone oil (SO) tamponade (odds ratio = 5.659, P = 0.021) and hydrophilic IOL (OR = 5.309, P = 0.022) were associated with IOL tilt over 7 degrees, and diabetes mellitus (DM OR = 5.544, P = 0.033) was associated with IOL decentration over 0.4 mm. The mean IOL tilt and decentration were greater in the PPV group (5.36 ± 2.50 degrees and 0.27 ± 0.17 mm, respectively) than in the non-PPV group (4.54 ± 1.46 degrees, P = 0.005 0.19 ± 0.12 mm, P < 0.001, respectively). IOL tilt and decentration were measured by SS-OCT (CASIA2) 3 months postoperatively. One hundred four eyes with prior PPV and 104 eyes without PPV undergoing uneventful cataract surgery were enrolled in this study. The purpose of this study was to investigate the characteristics and risk factors of intraocular lens (IOL) tilt and decentration of phacoemulsification after pars plana vitrectomy (PPV) using swept-source optical coherence tomography (SS-OCT).
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