Tilt and decentration of the crystalline lens and intraocular lens after FLACS

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, nonrandomized, 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. A Pearson 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 < .0001), while CL and IOL decentration showed a moderate correlation ( R = 0.38, P < .0001). No significant correlation was found between IOL tilt and decentration ( R = 0.07, P = .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 before cataract surgery.