Short-term fluctuation of lens corneal distance and clinical
correlation with phacodonesis
Dhivya Ashok Kumar
Sumaiya Banu Samiullah
Received: 22 March 2017 /Revised: 13 November 2017 / Accepted: 11 December 2017 / Published online: 26 December 2017
Springer-Verlag GmbH Germany, part of Springer Nature 2017
Background To analyze the role of short-term lens–corneal distance (LCD) fluctuation in quantifying preoperative phacodonesis
and predicting intraoperative zonular weakness.
Methods Patients were divided into control (lens without clinical phacodonesis) and study (lens with suspicious and clinical
phacodonesis) groups for evaluation. Slit-lamp examination followed by IOLMaster (Carl Zeiss) for LCD assessment was
performed. Five readings were taken at five time points (0 s, 15 s, 30 s, 45 s & 60 s) continuously over a minute (short term)
for the LCD fluctuation calculation.
Results A total of 135 eyes (82 controls and 53 study) were assessed. Study group included 32 (60.3%) suspicious and 21
(39.6%) moderate to severe phacodonesis. There was difference between the control and study eyes (p =0.000)inshort-term
LCD fluctuation. Twenty-one study eyes (39.6%) showed LCD difference > 1 mm, including 11 eyes (52.3%) with > 2 mm.
There was a difference in LCD with respect to severity of phacodonesis (p = 0.000). In the study eyes, 13 eyes underwent glued
IOL implantation (clinical phacodonesis — ten, suspicious phacodonesis — three), and two eyes (suspicious phacodonesis) had
glued capsular hook. Thirteen eyes (clinical phacodonesis — ten, suspicious phacodonesis — three) required intraoperative
vitrectomy due to vitreous ingress. Intraoperative zonular weakness in 62.5% of eyes with suspicious donesis and association
(Chi-square = 0.000) of weakness with preoperative LCD fluctuation was noted.
Conclusions Short-term lens–corneal distance fluctuation can be used as a parameter for quantifying lens stability and as an aid in
assessing the intraoperative risk.
Lens–corneal distance (LCD)
Short-term fluctuation in LCD
Stability of the lens is a distinct and an essential clinical factor
which assists in preoperative planning and thereby prepares
the surgeon for intraoperative complications. In normal anat-
omy, the natural lens is immobile in the patellar fossa.
However, there are abnormal conditions in which the lens
moves or vibrates [1–4]. Zonular dehiscences after trauma or
congenital zonular weakness are the two common conditions
which may lead to lens motility. Abnormal movements of the
crystalline lens and the intraocular lens (IOL) are termed
Bphacodonesis^ and Bpseudophacodonesis^ repectively [5,
6]. There have been few reports in the past evaluating the
methods to detect or grade that abnormal movement of the
lens. Even though slit-lamp biomicroscopy has been the gold
standard method, it is subjective. Therefore, we have tried an
indirect method of assessing the lens motion, namely the
change or variation of the distance between the lens (which
IOLMaster, which works on the principle of partial coherence
interferometry. It has been used widely for preoperative biom-
etry including anterior chamber depth (ACD) evaluation.
ACD evaluation by IOLMaster, unlike the original AC depth
calculation, includes the corneal thickness along with anterior
chamber measurement, and it is non-axial. Hence we (D.A.K)
have termed it Blens–corneal distance^ or LCD for indirect
assessment of lens motion in this study. In this prospective
study, we have analyzed and compared the LCD changes
* Amar Agarwal
Dr. Agarwal’s Eye Hospital and Eye Research Centre, 19 Cathedral
Road, Chennai 600 086, India
Graefe's Archive for Clinical and Experimental Ophthalmology (2018) 256:567–573