The cases illustrate an insidious cause of decreased visual acuity after cataract surgery.
The purpose of this study was to identify cases of postoperative vision loss caused by slight intraocular lens (IOL) malpositioning after cataract surgery.
Three patients presented with visual acuity decreased after cataract surgery. Silt-lamp examination before mydriasis revealed no abnormalities in two of the patients; mild IOL inferonasal decentration was found by the trifocal IOL diffraction ring in the third patient. Manifest refraction of these patients showed remarkable astigmatism with low corneal astigmatism. After pupil dilation, slight IOL decentration and tilt were observed in all patients, which were further confirmed using the Scheimpflug imaging system. Wavefront aberrometry showed a high level of ocular higher-order aberrations, most of which were derived from intraocular aberrations.
Inconspicuous IOL malpositioning is one of the reasons responsible for decreased vision acuity after cataract surgery, which may not be easily identified by slit-lamp examination. High astigmatism and ocular higher-order aberrations derived from malpositioned IOL can be important clues.
1Department of Ophthalmology and the Eye Institute, Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
2Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China
3Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, People's Republic of China
4Key NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
5Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, People's Republic of China
6Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
Submitted: September 21, 2018
Accepted: June 12, 2019
XR, AM, and JY contributed equally to this work and are considered co-first authors.
Funding/Support: This study was funded by grants from the National Natural Science Foundation of China (grant nos. 81470613 and 81870642, 81300806), Shanghai High Myopia Study Group, Shanghai Talent Development Fund (grant no. 201604), and Outstanding Youth Medical Talents Program of Shanghai Health and Family Planning Commission (grant no. 2017YQ011).
Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.
Author Contributions: Data Curation: XR; Formal Analysis: XR, WH; Funding Acquisition: XR, YL, XZ; Methodology: XZ; Supervision: YL, XZ; Writing - Original Draft: XR, AM, YD; Writing - Review & Editing: JY, YL, XZ.