Analysis of intraocular lens decentration and tilt after femtosecond laser-assisted cataract surgery using swept-source anterior optical coherence tomography

Objective 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). Methods 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. Results 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. Conclusion 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.