In our case, we employed iTrace a ray-tracing aberrometer as a diagnostic tool for finding the cause for ocular aberration and helped us to rule out IOL tilt or decentration. When it comes to diagnosing IOL tilt or decentration, previously, Purkinje imaging technique, AS-OCT, Scheimplug imaging, and UBM were employed. Our case is one such rare presentation as iris-claw IOL tilt was noted in spite of good enclavation and no vitreous prolapse. The cause of the iris-claw IOL tilt includes disenclavation of one of the haptic, which is unique and reported to be 8.7%. Nevertheless, after few years following an uneventful cataract surgery, capsular fibrosis is a common cause for tilt and decentration in horizontal and vertical meridians. While long axial length, thicker lens, larger capsulorhexis, and severely malformed capsulorhexis were confirmed to increase the risk of IOL decentration,, , previous pars plana vitrectomy and short axial length had a positive correlation with IOL tilt. Causes of tilt or decentration include asymmetrical IOL fixation (partly in bag and partly in sulcus) and capsular tear during capsulorhexis. IOL tilt and decentration have a negative impact on the visual performance by introducing optical aberration and in extreme cases may cause decreased visual acuity. The patient had no complaints of glare and halos, and he was highly satisfied.įigure 1: Slit-lamp image: yellow arrow showing iris-claw IOL in situ red arrow showing superior sector iridectomyįigure 2: iTrace map showing more internal higher-order aberration and high astigmatismįigure 3: iTrace showing reduced higher-order aberration and astigmatism after deenclavation of iris.claw IOL and implantation of SFIOLĬorrect alignment of IOL is very important for visual function following cataract surgery. iTrace showed almost reduced internal HOA. Postoperatively, his BCVA with −1.00 D spherical/−2.50 D cylinder 24° was 6/9p. He underwent IOL de-enclavation with SFIOL implantation. Local aberration at the level of the cornea was normal but at the level of lens, patient had more second-order aberration astigmatism and higher-order aberration coma and trefoil the cause of this HOA was IOL mild tilt. Based on his symptoms, we decided to take I–trace. On examination of the anterior segment, iris-claw was well enclaved behind the pupillary margin with mild IOL tilt on looking up. On examination after 15 days, his best-corrected visual acuity with −9D spherical/−4D cylinder 160° was 6/18. In due course of time, the patient had complaints of glare, halos, starburst, diplopia, and decreased vision. The immediate post-operative vision was 6/9 and showed well enclaved iris-claw IOL. Although many technologies are available, we implemented an easy and effective way in diagnosing iris-claw IOL tilt and planning further management.Ī 65-year-old male patient underwent right eye secondary IOL implantation, iris-claw IOL, for post-operative aphakia with superior sectoral iridectomy. One of the causes of higher-order aberration after surgery is IOL tilt and decentration. When it comes to higher-order aberration, it causes more disturbance in visual performance. In modern ophthalmology, after cataract refractive surgery apart from visual acuity, visual function plays an important role in patient satisfaction. Indian J Ophthalmol Case Rep 2022 2:87-9. iTrace - A diagnostic tool in iris-claw intraocular lens tilt. How to cite this URL: Priya AA, Saraswathy B, Sagam N, Narendran K. How to cite this article: Priya AA, Saraswathy B, Sagam N, Narendran K. Keywords: iTrace aberrometer, IOL tilt, iris-claw IOL To the best of our knowledge, no previous studies or case reports have mentioned this technology to diagnose iris-claw IOL tilt. We report a rare presentation of iris-claw IOL tilt in spite of good enclavation and an easy and effective diagnostic tool in iris-claw IOL tilt by iTrace, a ray-tracing aberrometer. An increase in higher-order aberration caused by tilt and decentration of the intraocular lens can lead to a decrease in visual function following cataract surgery.
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