Clinically Significant Intraocular Lens Decentration and Tilt in Highly Myopic Eyes: A Swept-Source Optical Coherence Tomography Study

PURPOSE To investigate the occurrence and risk factors of clinically significant intraocular lens (IOL) decentration and tilt in highly myopic eyes using swept-source anterior segment optical coherence tomography (SS-AS-OCT). DESIGN Cross-sectional study. METHODS This study included 334 participants (334 eyes) with high myopia, defined as axial length (AL) ≥26 mm, who underwent phacoemulsification with IOL implantation. Decentration and tilt of IOL were assessed by SS-AS-OCT. Clinically significant IOL decentration and tilt was defined as decentration ≥0.4 mm and tilt ≥7°. Routine preoperative and postoperative examinations included visual acuity, refraction, biometric measurement using IOLMaster 700 (Carl Zeiss Meditec), and objective visual quality evaluated by OPD-Scan III (Nidek Technologies). RESULTS Among the 334 highly myopic participants, 71 (21.3%) had clinically significant IOL decentration, and 26 (7.78%) had clinically significant IOL tilt. The proportion of clinically significant IOL decentration (37.1% vs 14.0%, P < .001) and tilt (16.2% vs 3.90%, P < .001) in those with AL ≥30 mm was significantly higher than in those with AL <30 mm. The multivariable logistic regression model showed only AL ≥30 mm was associated with clinically significant IOL decentration (odds ratio, 1.65; P = .002). AL ≥30 mm (odds ratio, 2.09; P = .001) was an independent risk factor for clinically significant IOL tilt after adjusting for confounders. AL ≥30.3 mm could effectively predict IOL decentration ≥0.6 mm (area under the curve, 0.802). CONCLUSIONS Participants with AL >30 mm have a higher risk of clinically significant IOL decentration and tilt, thus caution should be taken to implant multifocal or toric IOL for these patients. To investigate the occurrence and risk factors of clinically significant intraocular lens (IOL) decentration and tilt in highly myopic eyes using swept-source anterior segment optical coherence tomography (SS-AS-OCT). Cross-sectional study. This study included 334 participants (334 eyes) with high myopia, defined as axial length (AL) ≥26 mm, who underwent phacoemulsification with IOL implantation. Decentration and tilt of IOL were assessed by SS-AS-OCT. Clinically significant IOL decentration and tilt was defined as decentration ≥0.4 mm and tilt ≥7°. Routine preoperative and postoperative examinations included visual acuity, refraction, biometric measurement using IOLMaster 700 (Carl Zeiss Meditec), and objective visual quality evaluated by OPD-Scan III (Nidek Technologies). Among the 334 highly myopic participants, 71 (21.3%) had clinically significant IOL decentration, and 26 (7.78%) had clinically significant IOL tilt. The proportion of clinically significant IOL decentration (37.1% vs 14.0%, P < .001) and tilt (16.2% vs 3.90%, P < .001) in those with AL ≥30 mm was significantly higher than in those with AL <30 mm. The multivariable logistic regression model showed only AL ≥30 mm was associated with clinically significant IOL decentration (odds ratio, 1.65; P = .002). AL ≥30 mm (odds ratio, 2.09; P = .001) was an independent risk factor for clinically significant IOL tilt after adjusting for confounders. AL ≥30.3 mm could effectively predict IOL decentration ≥0.6 mm (area under the curve, 0.802). Participants with AL >30 mm have a higher risk of clinically significant IOL decentration and tilt, thus caution should be taken to implant multifocal or toric IOL for these patients.