Tilt and Decentration of the Crystalline Lens and Intraocular Lens After Femtosecond Laser-Assisted Cataract Surgery

Purpose: To evaluate crystalline lens (CL) and intraocular lens (IOL) tilt and decentration after uneventful femtosecond laser-assisted cataract surgery (FLACS) in Caucasian eyes. Setting: Clínica Miranza Madrid, Spain. Design: Retrospective, observational, interventional, non-randomized, single-center study. Methods: This study included 125 consecutive eyes from 125 patients undergoing FLACS. CL and IOL tilt and decentration were assessed using the built-in analysis software of the CASIA2 anterior segment optical coherence tomography (AS-OCT) system. Univariate and multivariate regression analyses identified associations between biometric parameters and both CL and IOL tilt and decentration. Pearson’s correlation coefficient evaluated the relationship between CL and IOL values. Differences across IOL platforms in relation to preoperative CL tilt and decentration were explored. Results: Mean preoperative CL tilt was 5.20 ± 1.35 degrees and decentration was 0.16 ± 0.09 mm. At 1 month postoperatively, mean IOL tilt was 5.08 ± 1.33 degrees and decentration was 0.23 ± 0.12 mm. CL tilt strongly correlated with IOL tilt (R = 0.80, P < 0.0001), while CL and IOL decentration showed a moderate correlation (R = 0.38, P < 0.0001). No significant correlation was found between IOL tilt and decentration (R = 0.07, P = 0.439). Axial length was a significant predictor of both CL and IOL tilt. Age significantly predicted CL decentration and showed a modest association with IOL decentration. Conclusions: In Caucasian eyes undergoing FLACS, preoperative CL position correlates with postoperative IOL alignment. AS-OCT analysis of CL geometry may aid in predicting IOL behavior prior to cataract surgery.