MICROSCOPE-INTEGRATED INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY FOR INTRAOCULAR LENS TILT EVALUATION DURING SCLERAL-SUTURE FIXATION.

Abstract

The aim of this study was to evaluate the feasibility and clinical utility of a commercially available microscope-integrated intraoperative optical coherence tomography (MI-OCT) system during scleral-sutured fixation of intraocular lenses (IOLs). Scleral-sutured IOL fixation was performed in 18 eyes using the Zeiss Rescan 700 MI-OCT system. Intraoperative optical coherence tomography images were captured, and the utility of MI-OCT in the procedure was assessed. Eighteen eyes from 18 patients underwent scleral-sutured IOL fixation using the MI-OCT system. The system provided clear anterior segment images in all cases. In 15 cases, the captured images provided crucial information for evaluating IOL tilt in at least one meridian (0° or 90°). In the remaining cases, failure to assess tilt was attributed to iris asymmetry (2 cases) or a very posteriorly positioned IOL (1 case) in both horizontal and vertical meridians. In 16 cases with at least 3 months of follow-up, spherical equivalent significantly improved (preoperative: +5.72 ± 6.97 D; postoperative: -1.57 ± 1.77 D; P = 0.004), while corneal endothelial cell density, best-corrected visual acuity, and intraocular pressure remained stable. Postoperative Pentacam HR imaging demonstrated a mean IOL tilt of 0.98 ± 0.93° horizontally and 1.67 ± 1.37° vertically. The commercial MI-OCT system enabled intraoperative evaluation of IOL tilt during scleral-sutured IOL fixation, although its utility was limited in cases involving asymmetric iris or posteriorly located IOLs. Future systems with wider and deeper scanning ranges and the ability to reference the anterior chamber angle may enhance performance.