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 Table of Contents  
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 87-89

iTrace - A diagnostic tool in iris-claw intraocular lens tilt

Department of Cataract and IOL, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India

Date of Submission07-Jul-2021
Date of Acceptance16-Aug-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Arut A Priya
Department of Cataract and IOL Aravind Eye Hospital, Coimbatore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1835_21

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An increase in higher-order aberration caused by tilt and decentration of the intraocular lens can lead to a decrease in visual function following cataract surgery. We report a rare presentation of iris-claw IOL tilt in spite of good enclavation and an easy and effective diagnostic tool in iris-claw IOL tilt by iTrace, a ray-tracing aberrometer. To the best of our knowledge, no previous studies or case reports have mentioned this technology to diagnose iris-claw IOL tilt.

Keywords: iTrace aberrometer, IOL tilt, iris-claw IOL

How to cite this article:
Priya AA, Saraswathy B, Sagam N, Narendran K. iTrace - A diagnostic tool in iris-claw intraocular lens tilt. Indian J Ophthalmol Case Rep 2022;2:87-9

How to cite this URL:
Priya AA, Saraswathy B, Sagam N, Narendran K. iTrace - A diagnostic tool in iris-claw intraocular lens tilt. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 23];2:87-9. Available from: https://www.ijoreports.in/text.asp?2022/2/1/87/334914

In modern ophthalmology, after cataract refractive surgery apart from visual acuity, visual function plays an important role in patient satisfaction. When it comes to higher-order aberration, it causes more disturbance in visual performance. One of the causes of higher-order aberration after surgery is IOL tilt and decentration. Although many technologies are available, we implemented an easy and effective way in diagnosing iris-claw IOL tilt and planning further management.

  Case Report Top

A 65-year-old male patient underwent right eye secondary IOL implantation, iris-claw IOL, for post-operative aphakia with superior sectoral iridectomy. The immediate post-operative vision was 6/9 and showed well enclaved iris-claw IOL. In due course of time, the patient had complaints of glare, halos, starburst, diplopia, and decreased vision. On examination after 15 days, his best-corrected visual acuity with −9D spherical/−4D cylinder 160° was 6/18. On examination of the anterior segment, iris-claw was well enclaved behind the pupillary margin with mild IOL tilt on looking up [Figure 1]. Fundus was within normal limits. Based on his symptoms, we decided to take I–trace. Local aberration at the level of the cornea was normal but at the level of lens, patient had more second-order aberration astigmatism and higher-order aberration coma and trefoil [Figure 2]; the cause of this HOA was IOL mild tilt. He underwent IOL de-enclavation with SFIOL implantation. Postoperatively, his BCVA with −1.00 D spherical/−2.50 D cylinder 24° was 6/9p. iTrace showed almost reduced internal HOA [Figure 3]. The patient had no complaints of glare and halos, and he was highly satisfied.
Figure 1: Slit-lamp image: yellow arrow showing iris-claw IOL in situ; red arrow showing superior sector iridectomy

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Figure 2: iTrace map showing more internal higher-order aberration and high astigmatism

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Figure 3: iTrace showing reduced higher-order aberration and astigmatism after deenclavation of iris.claw IOL and implantation of SFIOL

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  Discussion Top

Correct alignment of IOL is very important for visual function following cataract surgery. IOL tilt and decentration have a negative impact on the visual performance by introducing optical aberration and in extreme cases may cause decreased visual acuity.[1] Causes of tilt or decentration include asymmetrical IOL fixation (partly in bag and partly in sulcus) and capsular tear during capsulorhexis.[2] While long axial length, thicker lens, larger capsulorhexis, and severely malformed capsulorhexis were confirmed to increase the risk of IOL decentration,[3],[4],[5] previous pars plana vitrectomy and short axial length had a positive correlation with IOL tilt.[5] Nevertheless, after few years following an uneventful cataract surgery, capsular fibrosis is a common cause for tilt and decentration in horizontal and vertical meridians.[6] The cause of the iris-claw IOL tilt includes disenclavation of one of the haptic, which is unique and reported to be 8.7%.[7] Our case is one such rare presentation as iris-claw IOL tilt was noted in spite of good enclavation and no vitreous prolapse.

When it comes to diagnosing IOL tilt or decentration, previously, Purkinje imaging technique, AS-OCT, Scheimplug imaging, and UBM were employed.[8] In our case, we employed iTrace a ray-tracing aberrometer as a diagnostic tool for finding the cause for ocular aberration and helped us to rule out IOL tilt or decentration. The ray-tracing aberrometer uses a laser beam (655 nm) parallel to the visual axis through the pupil and measures the exact location where the laser beam reaches the retina by using a retro reflected light captured by the reference linear sensors X and Y. This combines both wavefront aberrometry as well as placid based corneal topography and hence it has an advantage over other aberrometers in providing individually for corneal and internal aberrations along with total aberration.[9]

The HOA causes subjective symptoms such as glare and halo, which cannot be quantified by refraction and corrected by spectacles or contact lens. These are very important after cataract and refractive surgery, who complaints of poor vision despite of achieving a good visual acuity.[8] Based on the patient's symptoms, we performed iTrace and it showed more internal HOA; this was due to mild iris-claw IOL tilt. After deenclavation of it and implanting SFIOL, the patient's HOA was almost reduced and visual quality improved.

  Conclusion Top

Based on our case report, we hereby conclude that iTrace is a very easy and new technology in diagnosing even minimal Iris-claw IOL tilt. We have implemented it practically and suggest i-Trace as an effective, easy, and new diagnostic tool that can be helpful in diagnosing even minimal IOL tilt.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Hayashi K, Hayashi H, Nakao F, Hayashi F. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens. Ophthalmology 2001;108:2011-7.  Back to cited text no. 1
Ale JB. Intraocular lens tilt and decentration: A concern for contemporary IOL designs. Nepal J Ophthalmol 2011;3:68-77.  Back to cited text no. 2
Findl O, Hirnschall N, Draschl P, Wiesinger J. Effect of manual capsulorhexis size and position on intraocular lens tilt, centration, and axial position. J Cataract Refract Surg 2017;43:902-8.  Back to cited text no. 3
Zhu X, He W, Zhang Y, Chen M, Du Y, Lu Y. Inferior decentration of multifocal intraocular lenses in myopic eyes. Am J Ophthalmol 2018;188:1-8.  Back to cited text no. 4
Chen X, Gu X, Wang W, Xiao W, Jin G, Wang L, et al. The characteristics and factors associated with intraocular lens tilt and decentration after cataract surgery. J Cataract Refract Surg 2020;46:1126-31.  Back to cited text no. 5
Uzel MM, Ozates S, Koc M, Uzel AGT, Yılmazbaş P. Decentration and tilt of intraocular lens after posterior capsulotomy. Semin Ophthalmol 2018;33:766-71.  Back to cited text no. 6
Gonnermann J, Klamann MK, Maier AK, Rjasanow J, Joussen AM, Bertelmann E, et al. Visual outcome and complications after posterior iris-claw aphakic intraocular lens implantation. J Cataract Refract Surg 2012;38:2139-43.  Back to cited text no. 7
Sinha A, Goel S, Gupta V, Kumawat D, Sahay P. iTrace- A ray tracing aberrometer. DJO 2019;30:72-5.  Back to cited text no. 8
Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. Effect of intraocular lens tilt and decentration on visual acuity, dysphotopsia and wavefront aberrations. Vision 2020;4:41.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3]


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