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Purpose: To compare the lens tilt after apex-centered capsulotomy with standard pupil-centered capsulotomy. Setting: Clinical practice. Design: Prospective, randomized, investigator-masked trial. Methods: This prospective, randomized, investigator masked study included 40 patients with age-related cataract scheduled for femtosecond laser-assisted cataract surgery (FLACS) in both eyes. The main outcome was the tilt of the intraocular lens (IOL), measured with the IOLMaster 700. Results: The study enrolled 80 eyes of 40 patients. The mean distance from the center of the apex-centered capsulotomy to the pupil-centered capsulotomy was 175.8 +/- 97.2 [mu]m. The amount of IOL tilt was not significantly reduced with the new technique (P >.05). Tilt orientation was more stable in eyes treated with apex-centered capsulotomy. Conclusions: Centration of the capsulotomy on the lens apex in FLACS does not influence the amount of IOL tilt but the orientation stability. The clinical importance of this finding has to be further elucidated. [ABSTRACT FROM AUTHOR]

Introduction: We conducted an evaluation of capsular bag performance of the Clareon CNA0T0 intraocular lens (IOL), focusing on postoperative anterior chamber depth (ACD), IOL tilt, and IOL decentration. Methods: Inclusion criteria were bilateral age-related cataract and the ability to provide informed consent. Exclusion criteria were prior surgeries, combined surgeries, and conditions posing a risk for postoperative capsular bag instability. Preoperative and 8-week postoperative assessments included optical biometry and high-resolution anterior segment optical coherence tomography (OCT). Subjective refraction was conducted only at 8 weeks postoperative visit. Results: In the first analysis, 49 right eyes of 49 patients were included. Mean preoperative and postoperative ACD were 3.10 and 4.69 mm, respectively. Mean preoperative tilt was 4.77°, increasing to 5.06° postoperatively. Preoperative decentration was 0.16 mm, increasing to 0.26 mm postoperatively. Absolute refractive error (ARE) was + 0.31D, with 81% of eyes within ± 0.5D limits. In analysis II (98 eyes of 49 patients), both eyes showed a moderate correlation in IOL tilt (Pearson correlation coefficient: 0.27, p = 0.061) and a low correlation in IOL decentration (Pearson correlation coefficient: 0.02, p = 0.892) and ARE (Spearman: 0.15, p = 305) between right and left eyes of the same patient. Conclusions: The Clareon CNA0T0 IOL demonstrated high mechanical stability, with low postoperative tilt and decentration values, resulting in excellent refractive outcomes and visual acuity. These findings confirm the IOL's high stability within the capsular bag and effectiveness in minimizing postoperative refractive error, requiring only minor A-constant adjustments for optimal cataract surgery outcomes. Trial Registration: NCT06595693. [ABSTRACT FROM AUTHOR]

Purpose: To use a combination of partial least squares regression and a machine learning approach to predict intraocular lens (IOL) tilt using preoperative biometry data. Setting: Kepler University Clinic Linz, Linz, Austria. Design: Prospective single-center study. Methods: Optical coherence tomography, autorefraction, and subjective refraction were performed at baseline and 8 weeks after cataract surgery. In analysis I, only 1 eye per patient was included and a tilt prediction model was generated. In analysis II, a pairwise comparison between right and left eyes was performed. Results: In analysis I, 50 eyes of 50 patients were analyzed. Difference in amount, orientation, and vector from preoperative to postoperative lens tilt was -0.13 degrees, 2.14 degrees, and 1.20 degrees, respectively. A high predictive power (variable importance for projection [VIP]) for postoperative tilt prediction was found for preoperative tilt (VIP = 2.2), pupil decentration (VIP = 1.5), lens thickness (VIP = 1.1), axial eye length (VIP = 0.9), and preoperative lens decentration (VIP = 0.8). These variables were applied to a machine learning algorithm resulting in an out of bag score of 0.92 degrees. In analysis II, 76 eyes of 38 patients were included. The difference of preoperative to postoperative IOL tilt of right and left eyes of the same individual was statistically relevant. Conclusions: Postoperative IOL tilt showed excellent predictability using preoperative biometry data and a combination of partial least squares regression and a machine learning algorithm. Preoperative lens tilt, pupil decentration, lens thickness, axial eye length, and preoperative lens decentration were found to be the most relevant parameters for this prediction model. [ABSTRACT FROM AUTHOR]