The effect on post-operative intraocular lens centration by manual intraoperative centration versus auto-centration

Introduction: To determine if intraoperative manual centration of the intraocular lens (IOL) during cataract surgery results in better early post-operative centration. It is common practice for cataract surgeons to align intraocular lens centration to the visual axis by manual intraoperative manipulation of the intraocular lens. We aim to compare post-operative intraocular lens centration between intraocular lenses that were allowed spontaneous positioning in the capsular bag and IOLs that were manually centred during implantation. Materials and Methods: One hundred and twenty-five consecutive eyes that underwent either femtosecond laser-assisted cataract surgery (FLACS) or phacoemulsification and IOL (monofocal/toric/multifocal) implantation by a single surgeon were included. Post-operative IOL centration at 4 weeks was assessed and measured on a slit-lamp by a masked observer. Results: A total of 17 (13.6%) IOLs were off-centered to some extent at 4 weeks post-operatively. All the decentered IOLs were graded as minimal or mild (<0.5mm) decentration. There was no statistically significant difference in the proportion of decentered IOLs between the manual centration group and non-centration group (p = 0.59). Conclusion: The final position of the IOL is not dependent on manual centration but rather on the design and symmetry of the IOL, as well as the integrity of the capsular bag.