Measurement of crystalline lens tilt in high myopic eyes before cataract surgery using swept-source optical coherence tomography

Qiang Lu, Wenwen He, Dongjin Qian, Yi Lu, Xiangjia Zhu, Qiang Lu, Wenwen He, Dongjin Qian, Yi Lu, Xiangjia Zhu

Abstract

Background: To measure the crystalline lens tilt in eyes with various degrees of myopia before cataract surgery using swept-source optical coherence tomography (SS-OCT).

Methods: We used SS-OCT (IOLMaster 700) to scan 131 emmetropic eyes (axial length < 24.5 mm), 25 mild/moderate myopic eyes (axial length 24.5-26 mm), and 123 high myopic eyes (52, 29, and 42 eyes with axial lengths of 26-28, 28-30, and > 30 mm, respectively) as part of the routine preoperative examination before cataract surgery. SS-OCT involved B-scans along six meridians. The data were analyzed to assess the magnitude and orientation of the lens tilt and their correlation with other optical biometric parameters.

Result: The mean tilt was 3.36 ± 0.98° in emmetropic eyes, 3.07 ± 1.04° in mild/medium myopic eyes, and 2.35 ± 1.01° in high myopic eyes. Tilt correlated significantly and inversely with axial length (Pearson's r = - 0.427, P < 0.001). The crystalline lens tilt predominantly faced the upper outer quadrant relative to the visual axis, symmetrically in both eyes, with mean angles of 24.32° and 147.36° in the right and left eyes, respectively. The variability in the lens tilt direction increased with increasing axial length (χ2 test, P < 0.001).

Conclusion: The magnitude of crystalline lens tilt decreased with increasing axial length. The direction of tilt was predominantly towards the upper outer quadrant in both eyes. The variability in the tilt orientation increased with increasing axial length.

Trial registration: NIH (clinicaltrial.gov), NCT03062085. Registered 23 February 2017.

Keywords: Crystalline lens tilt; High myopia; Magnitude; Orientation; Swept-source optical coherence tomography.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Schematic diagram of the calculation of lens tilt in the space rectangular coordinate system (O-XYZ). OP is the unit normal vector for the lens plane. OA is the projection of OP on the X–Y plane. Angle ρ is the angle between OP and the Z-axis and represents the magnitude of the lens tilt. Angle φ is the angle between OA and the X-axis, and represents the direction of the lens tilt. X-axis: horizontal axis; Y-axis: vertical axis; Z-axis: visual axis
Fig. 2
Fig. 2
Patient flow
Fig. 3
Fig. 3
Correlation between axial length and angle ρ. The line of best fit was y = − 1.325x + 29.831 (R = 0.427, P < 0.001)
Fig. 4
Fig. 4
Orientation of crystalline lens tilt. (a, b) Schematic diagram of lens tilt in the right (a) and left eyes (b). Lenses from both eyes are facing towards the upper outer quadrants. A gray shadow was added for better visualization. (c, d) Polar scatterplots showing the magnitude (angle ρ) and orientation (angle φ) of lens tilt in the right (b) and left (c) eyes. Each ring represents 1°. (e) Stacked column graph of the lens tilt orientations in the different groups according to axial length. UOQ: upper outer quadrant; LOQ: lower outer quadrant; LIQ: lower inner quadrant; UIQ: upper inner quadrant

References

    1. Vitale S, Ellwein L, Cotch MF, Ferris FL, 3rd, Sperduto R. Prevalence of refractive error in the United States, 1999-2004. Arch Ophthalmol. 2008;126(8):1111–1119. doi: 10.1001/archopht.126.8.1111.
    1. Morgan I, Rose K. How genetic is school myopia? Prog Retin Eye Res. 2005;24(1):1–38. doi: 10.1016/j.preteyeres.2004.06.004.
    1. Wu HM, Seet B, Yap EP, Saw SM, Lim TH, Chia KS. Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Optom Vis Sci. 2001;78(4):234–239. doi: 10.1097/00006324-200104000-00012.
    1. Rein DB, Zhang P, Wirth KE, Lee PP, Hoerger TJ, McCall N, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124(12):1754–1760. doi: 10.1001/archopht.124.12.1754.
    1. Sun J, Zhou J, Zhao P, Lian J, Zhu H, Zhou Y, et al. High prevalence of myopia and high myopia in 5060 Chinese university students in Shanghai. Invest Ophthalmol Vis Sci. 2012;53(12):7504–7509. doi: 10.1167/iovs.11-8343.
    1. Wu LJ, You QS, Duan JL, Luo YX, Liu LJ, Li X, et al. Prevalence and associated factors of myopia in high-school students in Beijing. PLoS One. 2015;10(3):e0120764. doi: 10.1371/journal.pone.0120764.
    1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042. doi: 10.1016/j.ophtha.2016.01.006.
    1. Zhu XJ, Zhou P, Zhang KK, Yang J, Luo Y, Lu Y. Epigenetic regulation of αA-crystallin in high myopia-induced dark nuclear cataract. PLoS One. 2013;8(12):e81900. doi: 10.1371/journal.pone.0081900.
    1. Zhao Y, Li J, Lu W, Chang P, Lu P, Yu F, et al. Capsular adhesion to intraocular lens in highly myopic eyes evaluated in vivo using ultralong-scan-depth optical coherence tomography. Am J Ophthalmol. 2013;155(3):484–491. doi: 10.1016/j.ajo.2012.08.019.
    1. Wong YL, Saw SM. Epidemiology of pathologic myopia in asia and worldwide. Asia Pac J Ophthalmol (Phila) 2016;5(6):394–402. doi: 10.1097/APO.0000000000000234.
    1. Norton Thomas T., Rada Jody A. Reduced extracellular matrix in mammalian sclera with induced myopia. Vision Research. 1995;35(9):1271–1281. doi: 10.1016/0042-6989(94)00243-F.
    1. Wilbrandt HR, Wilbrandt TH. Pathogenesis and management of the lens-iris diaphragm retropulsion syndrome during phacoemulsification. J Cataract Refract Surg. 1994;20(1):48–53. doi: 10.1016/S0886-3350(13)80043-0.
    1. Zhu X, Zhang K, He W, Yang J, Sun X, Jiang C, et al. Proinflammatory status in the aqueous humor of high myopic cataract eyes. Exp Eye Res. 2016;142:13–18. doi: 10.1016/j.exer.2015.03.017.
    1. Ji Y, Rao J, Rong X, Lou S, Zheng Z, Lu Y. Metabolic characterization of human aqueous humor in relation to high myopia. Exp Eye Res. 2017;159:147–155. doi: 10.1016/j.exer.2017.03.004.
    1. Zhu X, He W, Zhang Y, Chen M, Du Y, Lu Y. Inferior decentration of multifocal intraocular lenses in myopic eyes. Am J Ophthalmol. 2018;188:1–8. doi: 10.1016/j.ajo.2018.01.007.
    1. Hirnschall N, Buehren T, Bajramovic F, Trost M, Teuber T, Findl O. Prediction of postoperative intraocular lens tilt using swept-source optical coherence tomography. J Cataract Refract Surg. 2017;43(6):732–736. doi: 10.1016/j.jcrs.2017.01.026.
    1. Wang L. Guimaraes de Souza R, Weikert MP, Koch DD. Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer. J Cataract Refract Surg. 2019;45(1):35–40. doi: 10.1016/j.jcrs.2018.08.025.
    1. Tay E, Li X, Gimbel HV, Kaye G. Assessment of axial length before and after myopic LASIK with the IOLMaster. J Refract Surg. 2013;29(12):838–841. doi: 10.3928/1081597X-20130924-01.
    1. Seo MS, Lim ST, Kim HD, Park BI. Changes in refraction and axial length according to the viscosity of intraocular silicone oil. Korean J Ophthalmol. 1999;13(1):25–29. doi: 10.3341/kjo.1999.13.1.25.
    1. Jing Q, Tang Y, Qian D, Lu Y, Jiang Y. Posterior corneal characteristics of cataract patients with high myopia. PLoS One. 2016;11(9):e0162012. doi: 10.1371/journal.pone.0162012.
    1. Bullimore MA, Slade S, Yoo P, Otani T. An evaluation of the IOLMaster 700. Eye Contact Lens. 2019;45(2):117–123. doi: 10.1097/ICL.0000000000000552.
    1. Akman A, Asena L, Güngör SG. Evaluation and comparison of the new swept source OCT-based IOLMaster 700 with the IOLMaster 500. Br J Ophthalmol. 2016;100(9):1201–1205. doi: 10.1136/bjophthalmol-2015-307779.
    1. Zhang K, Zhu X, Chen M, Sun X, Yang J, Zhou P, et al. Elevated transforming growth factor-β2 in the aqueous humor: a possible explanation for high rate of capsular contraction syndrome in high myopia. J Ophthalmol. 2016;2016:5438676.
    1. Najjar DM, Igbre AO, Tsai FF. Late capsular bag contraction and intraocular lens subluxation in retinitis pigmentosa: a case report. J Med Case Rep. 2011;5:65. doi: 10.1186/1752-1947-5-65.
    1. Shigeeda T, Nagahara M, Kato S, Kunimatsu S, Kaji Y, Tanaka S, et al. Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag. J Cataract Refract Surg. 2002;28(9):1689–1693. doi: 10.1016/S0886-3350(01)01178-6.
    1. Mohebbi M, Bashiri SA, Mohammadi SF, Samet B, Ghassemi F, Ashrafi E, et al. Outcome of single-piece intraocular lens sulcus implantation following posterior capsular rupture during phacoemulsification. J Ophthalmic Vis Res. 2017;12(3):275–280. doi: 10.4103/jovr.jovr_181_15.
    1. Kimura S, Morizane Y, Shiode Y, Hirano M, Doi S, Toshima S, et al. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS One. 2017;12(9):e0184066. doi: 10.1371/journal.pone.0184066.
    1. de Castro A, Rosales P, Marcos S. Tilt and decentration of intraocular lenses in vivo from Purkinje and Scheimpflug imaging. Validation study. J Cataract Refract Surg. 2007;33(3):418–429. doi: 10.1016/j.jcrs.2006.10.054.
    1. Tabernero J, Piers P, Benito A, Redondo M, Artal P. Predicting the optical performance of eyes implanted with IOLs to correct spherical aberration. Invest Ophthalmol Vis Sci. 2006;47(10):4651–4658. doi: 10.1167/iovs.06-0444.
    1. Hu CY, Jian JH, Cheng YP, Hsu HK. Analysis of crystalline lens position. J Cataract Refract Surg. 2006;32(4):599–603. doi: 10.1016/j.jcrs.2006.01.016.
    1. Schwiegerling JT. Eye axes and their relevance to alignment of corneal refractive procedures. J Refract Surg. 2013;29(8):515–516. doi: 10.3928/1081597X-20130719-01.
    1. Smolek MK, Klyce SD, Sarver EJ. Inattention to nonsuperimposable midline symmetry causes wavefront analysis error. Arch Ophthalmol. 2002;120(4):439–447. doi: 10.1001/archopht.120.4.439.
    1. Chang DH, Waring GT., 4th The subject-fixated coaxially sighted corneal light reflex: a clinical marker for centration of refractive treatments and devices. Am J Ophthalmol. 2014;158(5):863–874. doi: 10.1016/j.ajo.2014.06.028.
    1. Xie R, Zhou XT, Lu F, Chen M, Xue A, Chen S, Qu J. Correlation between myopia and major biometric parameters of the eye: a retrospective clinical study. Optom Vis Sci. 2009;86(5):E503–E508. doi: 10.1097/OPX.0b013e31819f9bc5.
    1. Wen B, Yang G, Cheng J, Jin X, Zhang H, Wang F, et al. Using high-resolution 3D magnetic resonance imaging to quantitatively analyze the shape of eyeballs with high myopia and provide assistance for posterior scleral reinforcement. Ophthalmologica. 2017;238(3):154–162. doi: 10.1159/000477466.
    1. Zhu X, He W, Zhang K, Lu Y. Factors influencing 1-year rotational stability of Acrysof Toric intraocular lenses. Br J Ophthalmol. 2016;100(2):263–268. doi: 10.1136/bjophthalmol-2015-306656.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren