Influence of anterior capsulorhexis shape, centration, size, and location on intraocular lens position: Finite element model

Purpose: To evaluate the influence of anterior capsulorhexis shape, dimension, and eccentricity on intraocular lens (IOL) position. Setting: Laboratory investigation. Design: Computational model. Methods: A finite element model of the human crystalline lens capsule and zonule was created and the anterior capsule opened to simulate centered and decentered circular and elliptic rhexis. The model calculated capsular bag stress, IOL rotation, tilt, decentration, and vaulting, related to both capsular landmarks (absolute) and a reference IOL position defined as that obtained with a 5.0 mm circular and centered rhexis. Results: Mean von Mises stress along the IOL major z-axis was significantly higher than that along the perpendicular x-axis in all cases (P < .001), both at the equator and at the rhexis edge. Stress at the equator was always greater than that at the rhexis edge (P < .001) regardless of the rhexis shape and position. As rhexis eccentricity increased, the stress difference between the z- and x-axes increased. Absolute IOL tilt (range 10-1 to 10-7 degrees), decentration (10-3 to 10-7 mm), rotation (10-2 to 10-3 degrees), and vaulting (10-1 mm) were negligible from an optical standpoint, but all of them were significantly greater for decentered rhexis (both round and elliptic) compared with centered (P < .05). Conclusions: Anterior capsulorhexis irregularity and/or eccentricity increase IOL tilt, decentration, rotation, and vaulting in a numerically significant but optically negligible way. Von Mises stress is much greater at the capsular bag equator compared with the rhexis edge and highly asymmetrically distributed in all cases. Stress asymmetry may influence postoperative biologic processes of capsular bag shrinking and further IOL tilting or decentration.