After my intraocular lens procedure my new lens became tilted almost immediately, how after 3 eye examinations did the ophthalmic surgeon not know that the lens was tilted?
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One of the complications of cataract surgery is tilted intraocular lenses. During surgery, The main cause is weakness in the zonules or suspensory ligaments of the lens. These zonules attached to the capsule that surrounds the natural lens.This opacified lens or cataract is removed during the surgery leaving the capsule in place.
Other causes of tilted intraocular lens during surgery is the presence of viscoelastic material between the lens and the capsule and abnormal position of lens's haptics( Arms of the lens that hold the lens in place).
After cataract surgery the lens can change to its normal position due to many causes:
1- Vitreous humor that lies behind the capsule, can push the bag forward.
2- Fibrosis of the capsule which can lead to capsular contracture around the lens and change its position.
3- Drainage of the viscoelastic material between the lens and the capsule outside the eye.
During ocular examination, it can be difficult to notice if the lens is tilted or not especially if the pupil is small and not fully diluted.
It is hard to detect mild tilted lens through ocular examination and it can be detected only by the presence of astigmatism which is not due to cornea.