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Prospective, randomised, fellow eye study on relationship between changes in the ciliary sulcus and anterior chamber diameter based on preoperative axial length and anterior chamber depth after horizontal or vertical placement of intraocular lens.

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First Author: M.Nanavaty UK

Co Author(s):    C. Offer   C. Kier   P. Frattaroli   S. Bremner           

Abstract Details

Purpose:

To assess the relationship between changes in ciliary sulcus and anterior chamber diameters using ultrasound biomicroscopy (UBM) with horizontal or vertical placement of intraocular lens (IOL) in the capsular bag in relation to preoperative axial length (AL) and anterior chamber depth (ACD) in patients undergoing routine cataract surgery.

Setting:

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS trust, Brighton, UK.

Methods:

In this prospective, single surgeon, fellow-eye randomised study the first eye received the IOL horizontally or vertically in the capsular bag and the second eye received the opposite orientation within 3 weeks. Pre and 6-week postoperative assessment included uncorrected (UCVA) and best-corrected LogMAR visual acuity (BCVA), undilated UBM at 0-180o, 45-225o, 90-270o and 135-315o axes. Data on preoperative AL and ACD were collected from optical biometry. Change in the UBM sulcus and anterior chamber diameter along each axis and its Pearson correlation (r) with preoperative AL or ACD were assessed. Registered under NCT04208633; www.ClinicalTrials.gov.

Results:

46 patients (92 eyes) were recruited. Between horizontal and vertical groups, there was no significant difference in pre and postoperative LogMAR UCVA, BCVA, change in UBM sulcus and anterior chamber diameter. After horizontal placement of the IOL, there was a significant correlation between AL and change in horizontal sulcus for right (r=0.68 p=0.01) and left eyes (r =0.68, p=0.04). Whereas, after vertical placement of the IOL, there was a significant correlation between AL and ACD with change in vertical anterior chamber diameter in right (AL: r=0.71, p=0.01; ACD: r=0.66, p=0.02) and left eyes (AL: r=0.93, p<0.01; ACD: r=0.65, p=0.04) respectively.

Conclusions:

When the IOL is placed horizontally in the capsular bag, the change in sulcus diameter increases with increased AL on the horizontal axis only. This implies that in eyes with greater AL, horizontally placed toric piggyback IOLs are more likely to move postoperatively if the primary in-the-bag IOL is horizontal. When the IOL is placed vertically in the capsular bag, vertical anterior chamber diameter increases with increased AL or ACD. This implies that in eyes with greater AL or ACD, angle supported anterior chamber IOLs are likely to move postoperatively if they are placed vertically.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... research is funded, fully or partially, by a competing company, ... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, ... receives consulting fees, retainer, or contract payments from a competing company