Impact of intraocular lens haptic design and orientation on decentration and tilt

PURPOSE: To assess the effect of intraocular lens (IOL) orientation (vertical versus horizontal) and haptic design (1-piece versus 3-piece) on centration and tilt using a Purkinje meter. SETTING: Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. DESIGN: Randomized pilot study with intrapatient comparison. METHODS: In part 1 of this study, patients received plate-haptic IOLs (Akreos Adapt) in both eyes that were positioned vertically in 1 eye and horizontally in the other eye. In part 2, patients received a 1-piece IOL (Acrysof SA60AT) in 1 eye and a 3-piece IOL (Acrysof MA60AC) in the contralateral eye. Decentration and tilt were measured 1 month and 3 months postoperatively with a new Purkinje meter. RESULTS: In part 1 (n = 15), the mean decentration of plate-haptic IOLs was 0.4 mm ± 0.2 (SD) with vertical orientation and 0.4 ± 0.2 mm with horizontal orientation and the mean tilt, 1.5 ± 1.1 degrees and 2.9 ± 0.9 degrees, respectively. In part 2 (n = 15), the mean decentration was 0.4 ± 0.3 mm with 1-piece IOLs and 0.6 ± 0.8 mm with 3-piece IOLs and the mean tilt, 2.2 ± 7.2 degrees and 5.3 ± 2.4 degrees, respectively. CONCLUSIONS: Three-piece IOLs had a greater tendency toward more decentration than 1-piece IOLs, perhaps because of slight deformation of 1 or both haptics during implantation or inaccuracies in production when the haptics are manually placed into the optic. The IOL orientation for plate-haptic IOLs appeared to have no effect on IOL position. The Purkinje meter was useful in assessing the capsule bag performance of the IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.