Retina: intraoperative OCT measures IOL tilt
- Retina published a March 31 study by Sigeng Lin and colleagues showing microscope-integrated optical coherence tomography could measure lens tilt during scleral-sutured fixation surgery. - In 18 eyes, the Zeiss Rescan 700 provided usable tilt information in 15 cases; postoperative mean tilt measured 0.98° horizontally and 1.67° vertically. - The paper extends earlier intraoperative imaging work into a commercial system used during sutured fixation. (pubmed.ncbi.nlm.nih.gov)
When a replacement eye lens is sewn into place, even a small tilt can leave it off-center. A new Retina study says surgeons can measure that tilt during the operation itself. (scilit.com) The study, published March 31 in Retina, evaluated microscope-integrated optical coherence tomography, or MI-OCT, during scleral-sutured intraocular lens fixation. The authors were Sigeng Lin, Kaicheng Wu, Jiemei Shi, Hongmei Zhao, Xiaojing Huang, and Chunhui Jiang. (scilit.com) Optical coherence tomography is a light-based scan, like an ultrasound that uses reflected light instead of sound. In this study, the scan was built into the operating microscope with a Zeiss Rescan 700 system, so the surgeon could see the lens position while sewing it in place. (scilit.com) The team used the system in 18 eyes undergoing scleral-sutured fixation. In all 18, the device produced clear images of the front of the eye during surgery. (scilit.com) In 15 cases, those images gave what the paper called crucial information for judging lens tilt in at least one meridian, horizontal or vertical. In 3 cases, tilt could not be assessed because the iris was asymmetric in 2 eyes or the lens sat too far back in 1 eye. (scilit.com) At follow-up of at least 3 months in 16 eyes, the average spherical equivalent shifted from +5.72 diopters before surgery to -1.57 diopters after surgery. Best-corrected visual acuity, intraocular pressure, and corneal endothelial cell density stayed stable. (scilit.com) Postoperative Pentacam imaging found mean lens tilt of 0.98° horizontally and 1.67° vertically. The authors said wider and deeper scans, plus a way to reference the anterior chamber angle, could make future systems more useful. (scilit.com) This was not the group’s first pass at the problem. A 2023 Retina paper from Fudan University used a tailor-made intraoperative OCT system in 7 eyes and reported horizontal tilt of 0.74° and vertical tilt of 1.13° after two-point scleral suture fixation. (pubmed.ncbi.nlm.nih.gov) (europepmc.org) Related work has suggested why surgeons care about these angles. A 2023 Scientific Reports study of 43 eyes found mean tilt of 1.81° at the end of surgery and showed in experiments that steeper haptic insertion angles increased tilt sharply. (nature.com) The new Retina paper narrows that question to a commercial microscope-based system in sutured fixation, where lens position can shift as sutures are tightened. For training cases and complex secondary lens surgery, that means the measurement can happen before the patient leaves the operating room. (scilit.com)
