Intraocular Lens Positional Instability and Refractive Prediction Error after Cataract Surgery in Eyes with Retinitis Pigmentosa: A Comparative Study.

PURPOSE: To evaluate postoperative intraocular lens (IOL) positional instability in eyes with retinitis pigmentosa (RP) using anterior-segment optical coherence tomography (AS-OCT) and its association with refractive and visual outcomes.

METHODS

This retrospective study included 55 RP eyes and 83 normal control eyes after uncomplicated phacoemulsification with in-the-bag IOL implantation. IOL tilt and decentration were quantified using AS-OCT, and multivariable and sensitivity analyses were performed.

RESULTS

The RP group was younger than those in the normal control group (61.02 years vs. 72.06 years), non-single-piece IOLs were used only in RP eyes (49.1% vs. 0%), and the postoperative AS-OCT interval was longer in the RP group (1,107.73 days vs. 35.58 days, all p < 0.001). RP eyes showed more myopic prediction error (PE; -0.25 D vs. 0.08 D, p = 0.002), greater absolute prediction error (APE; 0.53 D vs. 0.36 D, p = 0.018), greater IOL tilt (5.90° vs. 4.87°, p = 0.007), and greater IOL decentration (0.29 mm vs. 0.20 mm, p = 0.002). In multivariable analyses, RP status was associated with greater IOL tilt (β = 1.040, p = 0.014), greater IOL decentration (β = 0.095, p = 0.005), more myopic PE (β = -0.463, p < 0.001), and greater APE (β = 0.294, p = 0.001). After adjustment for IOL design, the associations with IOL tilt and decentration were attenuated, whereas those with PE and APE remained significant.

CONCLUSIONS

RP eyes showed greater postoperative IOL positional instability and refractive unpredictability. The positional differences could not be attributed specifically to RP because of imbalances in postoperative timing and IOL design, whereas refractive PEs remained significant after adjustment for IOL design.