Impact of intraocular lens decentration and tilt on higher-order aberrations in patients with high and super-high myopia following cataract surgery.

PURPOSE: To evaluate how intraocular lens (IOL) positioning affects visual quality in patients with high myopia after cataract surgery.

METHODS: This prospective, randomized study was conducted on 50 eyes from 50 patients with high myopia (axial length [AL] >26 mm) or super-high myopia (AL >30 mm) who underwent cataract surgery between October 2022 and October 2023. We assessed the IOL position using optical coherence tomography and measured higher-order aberrations (HOAs) with the iTrace system. Correlations between IOL positioning and visual quality markers were then examined.

RESULTS: Follow-up rates were 100% (50 eyes) at 1 month and 84% (42 eyes) at 3 months post-surgery. At 1 month, IOL tilt showed a positive correlation with total HOAs in both the high and super-high myopia groups ( rs = 0.449, P = 0.010 and rs = 0.570, P = 0.017). IOL decentration was associated with specific aberrations: coma in the high myopia group ( rs = 0.492, P = 0.004) and trefoil in the super-high myopia group ( rs = 0.539, P = 0.026). At 3 months, IOL decentration negatively correlated with overall visual quality, measured by the modulation transfer function, in the high myopia group ( rs = -0.558, P = 0.001), but no significant correlation was observed in the super-high myopia group.

CONCLUSION: IOL positioning significantly affects visual quality in patients with high myopia after cataract surgery. The effects vary based on the degree of myopia and type of IOL misalignment. These findings emphasize the importance of precise IOL placement to optimize visual outcomes in this patient population.