A numerical model of capsulorhexis to assess the relevance of size and position of the rhexis on the IOL decentering and tilt

Finite element simulations of the mechanical stability of a post-cataract capsular bag demonstrate that a decentered and non-circular rhexis does not induce appreciable IOL decentering and tilt. Finite element models of human crystalline capsular bag and zonular fibers are used to estimate the mechanical response of the capsule to the presence of a C-loop Intra-Ocular Lens (IOL) after cataract surgery, to assess the influence of capsulorhexis size, shape and location on IOL decentration and tilt. The model includes, in the anterior capsule, a hole with variable size, shape and position, which represents the rhexis obtained in a manual or laser-assisted manner. The IOL is not explicitly modelled, but its action is reproduced by means of a set of elastic ties, connecting the opposite sides of the bag and exerting the force corresponding to an expanded IOL. Numerical simulations show that IOL decentration and tilt are not related to the size of the rhexis. A decentered rhexis induces IOL decentration <40 μm and a tilt <12°; the combination of non-circular shape and decentering of the rhexis induces IOL decentration <47 μm. While the introduction of a circular central rhexis causes an increment of the stresses in the capsule up to 100% relative to the physiological state, the combination of rhexis decentering and non-circular shape causes an additional 10% stress change. The values of IOL decentering and IOL tilt obtained from simulations are of scarce relevance in the clinical practice.