Morphologic Features of Crystalline Lens in Age-related Cataract Patients with Different Lens Sclerosis and Axial Length

Morphologic Features of Crystalline Lens in Age-related Cataract Patients with Different Lens Sclerosis and Axial Length | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Morphologic Features of Crystalline Lens in Age-related Cataract Patients with Different Lens Sclerosis and Axial Length Rui Qin, Jing Ding, Yiyun Liu, Qianqian Lan, Tong Sun, Linbo Bian, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5453837/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: To evaluate the morphological features of the crystalline lens in age-related cataract patients and to report the relationship of the lens nucleus sclerosis and axial length with lens morphology. Methods This retrospective cohort study were reviewed of age-related cataract patients scheduled for unilateral or bilateral cataract extraction with intraocular lens (IOL) implantation between July 2022 and June 2023 at Peking University Third Hospital. Preoperative examinations were conducted using a slit lamp, IOL Master 700 (Carl Zeiss, Germany), and CAISA2 (Tomey, Japan). Patients were categorized into different subgroups based on the degree of lens nucleus sclerosis (Emery-Little classification) and the axial length (AL), and statistical analysis was performed. Results 285 left eyes were included in the study. The mean age of the included patients was 69.69 ± 9.34 years, and the mean axial length was 23.89 ± 1.79 mm. Nuclear lens sclerosis was observed to have a negative correlation with the CRLPS (r = -0.171, P < 0.01) and crystalline lens diameter (r = -0.143, P < 0.05). Conversely, nuclear lens sclerosis was observed to have a positive correlation with crystalline lens decentration (r = 0.117, P < 0.05). Statistically significant differences were found in the correlation of AL with CRLAS (r = 0.186, P < 0.05), CRLPS (r = 0.154, P < 0.05), crystalline lens diameter (r = 0.128, P < 0.05), crystalline lens decentration magnitude (r = 0.089, P < 0.05), and crystalline lens tilt magnitude (r = -0.256, P < 0.01), respectively. There were also differences among different subgroups. The crystalline lens with Emery-Little classification IV were performed with a smaller posterior surface curvature radius, a smaller crystalline lens diameter and greater decentration than those with Emery-Little classification I-III. The crystalline lens in short AL eyes were performed with a smaller anterior and posterior surfaces curvature radius, a smaller crystalline lens diameter than these in normal and long AL eyes. The crystalline lens in long AL eyes were performed with greater lens tilt and decentration. Conclusion Crystalline lens with Emery-Little classification IV were mainly performed with abnormality in lens morphology and lens decentration. Lens with short AL were performed with abnormality in lens morphology, while that with long AL were performed with abnormality in lens decentration and tilt. Crystalline lens Cataract Biological parameter Lens Sclerosis Axial length Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Cataract remains a leading cause of blindness worldwide. Age-related cataract is the most prevalent form of cataract among adults, typically beginning in middle to late adulthood. With advancing age, the incidence of age-related cataracts rises markedly, from 3.9% in individuals aged 55–64 to 92.6% in those over 80 years of age 1 . As the demographic tapestry of the world tilts towards senescence, the prevalence of age-related cataracts is poised for a marked escalation. To combat the dimming vision caused by cataracts, surgical intervention remains the sole definitive remedy. Phacoemulsification with intracapsular implantation of artificial lens stands as the most prevalent and standardized technique at present 2 . Prior to cataract surgery, patients undergo a comprehensive preoperative assessment encompassing a detailed medical history and ophthalmic examination. Moreover, a comprehensive suite of ocular biometric measurements is essential for each patient 3 . Prior research has established a robust correlation between various ocular parameters 4 . Advancements in ocular biometry techniques have empowered ophthalmologists to gather a comprehensive array of biometric parameters during the preoperative assessment of cataract patients 5 , 6 . Obscured by the richly pigmented iris, a complete examination of the crystalline lens morphology remains elusive, even with pharmacologically dilated pupils. Employing a 1310 nm wavelength light source, CAISA2 (Tomey, Japan) generates a three-dimensional depiction of the anterior chamber by acquiring 128 cross-sectional images within a matter of seconds 7 . The device exhibits remarkable reproducibility and consistency 8 . Leveraging this device, recent studies have delved into the measurement of anterior segment biometric parameters, aiding ophthalmologists in their exploration of the crystalline lens tilt and decentration 9 , 10 . After excluding other possible diseases that may affect the morphological feature of the crystalline lens, we postulate that crystalline lens nuclear sclerosis and AL are potentially important factors influencing lens morphology. To date, no comprehensive study has evaluated the morphological differences of cataractous lenses with varying degrees of nuclear sclerosis and axial length. We aim to employ CAISAI2 to measure crystalline lens morphology, thereby providing a basis for individualized cataract surgery design, enhancing the safety and efficacy of the procedure. Methods Patients This retrospective share cross-sectional study enrolled consecutive patients scheduled for unilateral or bilateral cataract extraction with intraocular lens implantation between July 2022 and June 2023. All patients underwent a comprehensive ophthalmic and systemic medical history evaluation. We confined our observations to the left eye of the patients. This study was consistent with the Declaration of Helsinki for the use of human participants in biomedical research and received the approval of the Ethics Committee of Peking University Third Hospital (M2023663). An informed consent for participation in research was obtained from every patient. The inclusion criteria was followed: (1) Age ≥ 50 years old. (2) No restrictions of gender. (3) Definite diagnosis of age-related cataract. (4) Willingness to undergo unilateral or bilateral cataract surgery, including extracapsular cataract extraction (ECCE) or phacoemulsification. (5) Completion of preoperative anterior segment biometry measurements The exclusion criteria was followed: (1) Ophthalmic conditions as history of ocular trauma, genetic disorders causing lens ectopia or subluxation (e.g., Marfan syndrome, spherophakia and Marchesani syndrome). (2) Pseudophakic or aphakic eyes. (3) Difficulty in establishing a definitive diagnosis based on medical history, symptoms and clinical examination (4) Inability to complete essential preoperative examinations or poor quality. Preoperative examinations We recorded the patient demographics as age, gender and medical history. We recorded the anterior segment assessment: (1) Slit lamp examination to evaluate lens opacity and nuclear sclerosis. (2) IOL Master 700 (Carl Zeiss, Germany) to measure AL. (3) CASIA2 to measure crystalline lens parameters (Fig. 1 ): curvature radius of the lens anterior surface (CRLAS), curvature radius of the lens posterior surface (CRLPS), lens thickness, lens diameter and lens tilt and decentration. Lens tilt and decentration were tested by three-dimensional result, which was converted from 32 two-dimensional results. Each examination was performed by an experienced technician. Anterior segment photo data was reviewed by two researchers. For data with multiple measurements, we used image with highest quality and prioritized manual over automat ed measurements. All measurements were performed within three months before cataract surgery Sub-Grouping Patients were divided into four sub-grouping by the crystalline lens nuclear sclerosis using the Emery-Little classification. The slit lamp examination was performed in Fig. 2 . Group G1: Almost transparent, no nucleus, soft. Group G2: Nucleus is yellowish white or yellow, soft nucleus. Group G3: Nucleus is deep yellow, medium hardness nucleus. Group G4: Nucleus is brown or amber, hard nucleus. We had no Emery-Little classification grade VI patient. Another sub-grouping was based on AL. Group S: AL ≤ 22.5 mm (short eyes). Group N: AL 22.5 ~ 25.5 mm (normal eyes). Group L: AL ≥ 25.5 mm (long eyes) 11 . We compared the morphologic feature of crystalline lens in different sub-grouping. Statistical analysis Continuous variables were recorded as means and standard deviations (mean ± SD), and categorical variables as counts and percentages. Statistical analysis was performed with SPSS Statistics for Windows software (version 24.0, IBM Corp.). For examination results, Kolmogorov-Smirnov test was used to verify the normal distribution. Then one-way ANOVA or Kruskal-Wallis H test was used to compare the means. For the correlation between two variables, Pearson's correlation coefficient was used if both variables were continuous and normally distributed and Spearman's correlation coefficient was used at least one variable was non-normally distributed. A P-value less than 0.05 was considered statistically significant. Results A total of 320 eyes underwent preoperative examinations using both IOL Master 700 and CASIA2. Among these, 15 eyes were excluded due to severe crystalline lens opacity that precluded accurate AL measurement. Eight eyes were excluded due to a preoperative diagnosis of lens subluxation, six eyes due to non-age-related cataract, and six eyes due to unreliable examination results. 285 eyes (175 female and 110 male) were included in the study. The mean age of the included patients was 69.69 ± 9.34 years, and the mean axial length was 23.89 ± 1.79 mm. The details of crystalline lens morphologic features for the left eyes were presented in Table 1 . Table 1 Baseline characteristics of the patients Descriptive Statistics (n = 285) Ranges Mean ± SD Female/male 175/110 Age 50 to 91 69.69 ± 9.34 Axial length (mm) 21.12 to 32.40 23.89 ± 1.79 CRLAS (mm) 7.19 to 18.51 9.15 ± 1.23 CRLPS (mm) 4.13 to 7.35 5.66 ± 0.58 Lens thickness (mm) 3.05 to 6.23 4.67 ± 0.43 Lens diameter (mm) 7.46 to 11.40 9.95 ± 0.66 Decentration magnitude of the lens (mm) 0.02 to 0.58 0.15 ± 0.09 Tilt magnitude of the lens (°) 0.3 to 10.4 4.86 ± 1.54 SD = standard deviation, CRLAS = curvature radius of the lens anterior surface, CRLPS = curvature radius of the lens posterior surface. We conducted an analysis and comparison of the morphologic features in the crystalline lenses of eyes with varying degrees of nuclear lens sclerosis. A negative correlation was observed between the CRLPS and nuclear lens sclerosis (r = -0.171, P < 0.01). A negative correlation was also found between crystalline lens diameter and nuclear lens sclerosis (r = -0.143, P < 0.05). Conversely, a positive correlation was observed between crystalline lens decentration and nuclear lens sclerosis (r = 0.117, P < 0.05). Statistically significant differences were found between the groups in terms of CRLPS, crystalline lens diameter, and crystalline lens decentration, which was presented in Table 2 . Table 2 Correlation between hardness of the crystalline lens and crystalline lens biological parameters Biological Parameters Emery-Little Classification (mean ± SD) P value § Correlation G1 G2 G3 G4 Subjects (n) 63 97 82 43 CRLAS (mm) 9.06 ± 0.910 7.48–11.27 9.09 ± 1.37 7.19–18.51 9.29 ± 1.21 7.41–12.80 8.89 ± 1.06 7.56–10.97 0.313 r = 0.000 P = 0.998 CRLPS (mm) 5.71 ± 0.43 4.87–6.95 5.68 ± 0.52 4.33–6.63 5.67 ± 0.59 4.45–7.35 5.28 ± 0.73 4.13–7.20 <0.01 ** r= -0.171 P <0.01 ** Lens thickness (mm) 4.62 ± 0.43 3.80–5.26 4.70 ± 0.43 3.86–5.82 4.71 ± 0.45 3.63–5.80 4.58 ± 0.50 3.05–6.23 0.288 r = 0.02 P = 0.973 Lens diameter (mm) 10.03 ± 0.36 9.22–10.89 10.06 ± 0.57 8.22–10.98 10.05 ± 0.67 8.19–11.22 9.49 ± 0.15 7.46–11.40 <0.01 ** r = -0.143 P <0.05 * Decentration magnitude of the lens (mm) 0.13 ± 0.08 0.02–0.48 0.15 ± 0.08 0.02–0.37 0.13 ± 0.08 0.02–0.58 0.18 ± 0.12 0.02–0.56 <0.05 * r = 0.117 P <0.05 * Tilt magnitude of the lens (°) 4.68 ± 1.49 0.9–8.1 4.84 ± 0.17 0.3–10.1 4.87 ± 1.40 1.4–10.4 5.1 ± 1.65 2.2-8.0 0.599 r = 0.068 P = 0.255 SD = standard deviation, CRLAS = curvature radius of the lens anterior surface, CRLPS = curvature radius of the lens posterior surface. § Differences between groups were tested with the Kruskal-Wallis test. ** P value <0.01. * P value <0.05. Two-by-two comparisons of crystalline lens parameters between each group revealed that the CRLPS of group G4 was significantly lower than that of the other three groups (G1 vs G4: P < 0.01, G2 vs G4: P < 0.01, G3 vs G4: P < 0.01) (Fig. 3 A ) . Additionally, the crystalline lens diameter of group G4 was significantly smaller than that of the other three groups (G1 vs G4: P < 0.05, G2 vs G4: P < 0.01, G3 vs G4: P < 0.01) (Fig. 3 B). Conversely, the decentration magnitude of group G4 was significantly greater than that of the other three groups (G1 vs G4: P < 0.05, G2 vs G4: P < 0.05, G3 vs G4: P < 0.01) (Fig. 3 C). The morphology of crystalline lens was performed in Fig. 4 Subsequently, we conducted an analysis and comparison of the morphologic feature of the crystalline lenses in patients with varying AL. A positive correlation was observed between CRLAS and AL (r = 0.186, P < 0.05), and between CRLPS and AL (r = 0.154, P < 0.05). Additionally, a positive correlation was found between crystalline lens diameter and AL (r = 0.128, P < 0.05), and between crystalline lens decentration magnitude and AL (r = 0.089, P < 0.05). Conversely, a negative correlation was observed between crystalline lens tilt magnitude and AL (r = -0.256, P < 0.01). Statistically significant differences were found between the groups in terms of CRLAS, CRLPS, crystalline lens diameter, crystalline lens decentration magnitude, and crystalline lens tilt magnitude, which was presented in Table 2 . Table 3 Correlation between axial length and crystalline lens biological parameters Biological Parameters Axial length P value § Correlation S N L Subjects (n) 50 199 36 CRLAS (mm) 9.04 ± 1.75 7.41–18.51 9.10 ± 1.04 7.19–12.80 9.57 ± 1.26 7.27–11.50 <0.05 * r = 0.186 P <0.05 ** CRLPS (mm) 5.37 ± 0.60 4.15–6.84 5.69 ± 0.56 4.13–7.35 5.85 ± 0.0.53 4.91–6.95 <0.01 ** r = 0.154 P <0.05 * Lens thickness (mm) 4.71 ± 0.47 3.05–5.47 4.69 ± 0.41 3.40–6.23 4.57 ± 0.49 3.94–5.82 0.126 r = -0.091 P = 0.123 Lens diameter (mm) 10.03 ± 0.36 9.22–10.89 10.06 ± 0.57 8.22–10.98 10.05 ± 0.67 8.19–11.22 <0.05 * r = 0.128 P <0.05 * Decentration magnitude of the lens (mm) 0.15 ± 0.09 0.03–0.48 0.13 ± 0.06 0.02–0.58 0.19 ± 0.10 0.05–0.51 <0.05 * r = 0.089 P <0.05 * Tilt magnitude of the lens (°) 5.21 ± 1.49 2.8-8.0 5.05 ± 1.44 1.0-10.4 3.71 ± 1.79 0.3–6.7 <0.01 ** r = -0.256 P < 0.01 ** SD = standard deviation, CRLAS = curvature radius of the lens anterior surface, CRLPS = curvature radius of the lens posterior surface. § Differences between groups were tested with the Kruskal-Wallis test. ** P value <0.01. * P value <0.05. Two-by-two comparisons of crystalline lens parameters between each group revealed that the CRLAS of short AL eyes was significantly lower than that of long AL eyes (S vs L: P < 0.05) (Fig. 5 A). Additionally, the CRLPS of short axial eyes was significantly lower than that of normal AL and long AL eyes (S vs N: P < 0.01, S vs L: P < 0.01) (Fig. 5 B ) . There were significant differences in the sum of CRLAS and CRLPS between groups with different axial lengths, with short AL eyes having the lowest values and long AL eyes having the highest (S vs N: P < 0.05, S vs L: P < 0.01, N vs L: P < 0.05) (Fig. 5 C). The crystalline lens diameter of short AL eyes was significantly smaller than that of normal AL eyes (S vs N: P < 0.05) (Fig. 5 D). The crystalline lens decentration magnitude of long AL eyes was significantly greater than that of normal AL eyes (N vs L: P < 0.05) (Fig. 5 E). The crystalline lens tilt angle of long AL eyes was significantly lower than that of normal AL and short AL eyes (S vs L: P < 0.01, N vs L: P < 0.01) (Fig. 5 F). Discussion The morphologic features of crystalline lens play a pivotal role in influencing the safety and efficacy of cataract surgery. Severely opacified crystalline lenses pose significant challenges to the accurate measurement of preoperative biometric parameters 12 , 13 . A significantly hardened crystalline lens, characterized by advanced nuclear sclerosis potentially renders this technique ineffective for nuclear fragmentation 14 , 15 . The crystalline lens tilt and decentration can serve as valuable indicators of lens dislocation, subluxation, or ectopia 16 , 17 . Moreover, a correlation exists between the pre-operative position of the crystalline lens and the post-operative tilt and decentration of the implanted intraocular lens (IOL). Excessive IOL tilt or decentration can negatively impact post-operative visual quality 18 , 19 . Previous research has established that the decline in accommodative capacity is attributed to a combination of diminished ciliary muscle function and increased nuclear lens sclerosis, with the latter being the primary determinant 20 . Hence, this study represents the first endeavor to classify the crystalline lens based on nuclear lens sclerosis severity and compare the morphologic feature of lenses across different nuclear lens sclerosis grades. Our findings revealed that crystalline lenses with a smaller posterior surface curvature radius, a smaller crystalline lens diameter, and a greater crystalline lens decentration magnitude in the G4 group, which was presented in Fig. 4 . We consider that as nuclear lens sclerosis severity increases, lens opacity worsens, leading to more pronounced morphological alterations in the posterior equatorial region of the crystalline lens, which may elevate the risk of postoperative posterior capsule rupture 21 . The overall crystalline lens decentration magnitude was consistent with previous studies 9 . The greater crystalline lens decentration magnitude in the G4 group may be attributed to a combination of factors, including the smaller crystalline lens diameter, increased lens sclerosis, and ultimately, uneven tension exerted by the Zinn’s zonules. Recent research suggests a correlation between axial length and the crystalline lens the morphologic features. Patients with long AL exhibit a heightened susceptibility to two prevalent forms of cataracts: nuclear and posterior subcapsular 22 . Patients with short AL are predisposed to primary angle-closure glaucoma episodes, which may lead to Zinn’s zonular relaxation and subsequently impact crystalline lens morphology 23 . Accordingly, we stratified patients based on AL and compared the morphologic features of the crystalline lens across these groups. Our findings revealed that patients with short AL exhibited CRLAS and CRLPS, as well as a reduced crystalline lens diameter. However, no significant difference in crystalline lens thickness was observed. These results indicate that the anterior and posterior surfaces of the crystalline lens in short AL eyes are more convex, as presented in Fig. 6 . Intriguingly, Xiaolei W et al. revealed that patients with primary angle-closure disease (PACD) exhibited smaller CRLAS of the crystalline lens and greater lens thickness 10 . The discovery of a thickened crystalline lens may portend as a significant risk factor for the development of PACD in patients with short AL. Our findings also reveal a notable discrepancy in the sum of CRLAS and CRLPS across varying AL. This observation suggests a potential role of the crystalline lens in "refractive compensation" in response to refractive errors. In emmetropic eyes, the sum is intermediate. In hyperopic eyes with a short axial length, the sum is smaller, resulting in a higher refractive power of the lens and forward convergence of light rays. Conversely, in myopic eyes with a long axial length, the sum is larger, leading to a lower refractive power of the lens and backward convergence of light rays. Our findings indicate no significant difference in lens diameter between patients with long AL and those with normal AL. This observation contradicts the findings of Geethika et al., who reported a positive correlation between AL and lens diameter (r = 0.72, p < 0.01). This discrepancy might be attributed to the use of isolated human lens models for lens diameter measurement in their study, along with the inclusion of young individuals without cataracts 24 . Accurate lens diameter measurement empowers ophthalmologists to select appropriately sized capsular tension rings for patients with zonular weakness undergoing cataract surgery 25 , 26 . The crystalline lens tilt and decentration in patients with long AL exhibit pronounced deviations compared to those with normal and short AL. Previous studies have also established an inverse correlation between lens tilt and AL in patients with long AL, attributing to uneven force distribution on the lens due to zonular weakness 27 . We concur with the notion that the pronounced tilt and decentration observed in patients with long AL stem from uneven force distribution on the lens, rather than an enlarged capsular bag. The crystalline lens tilt and decentration are closely linked to IOL tilt and decentration following cataract surgery 28 . In non-spherical IOLs, tilt magnitude exceeding 7° and decentration magnitude greater than 0.4 mm can compromise visual quality to a certain extent. 29 Limitation Our study is subject to certain limitations. Firstly, while the axial length distribution of our included patients aligns with previous large-scale studies 11 , the proportion of eyes with normal AL significantly exceeds that of long and short axial length subjects. Secondly, despite including only patients aged 50 and above, the residual accommodative ability in some individuals might have influenced the measurement outcomes. Conclusion In age-related cataract patients with Emery-Little classification grade IV, the posterior surface of the crystalline lens is more convex, the crystalline lens diameter is smaller, and the crystalline lens decentration is greater, compared to lower grade patients. The anterior and posterior surfaces of the crystalline lens are more convex in patients with short AL than in patients with normal AL, while patients with long AL are more likely to have greater decentration and less tilt of the crystalline lens. Therefore, preoperative assessment of the crystalline lens hardness and morphology is essential. Declarations Acknowledgements We thank all the participants of the study. Medical Writing/Editorial Assistance We acknowledge Editage for editorial assistance during the preparation of this manuscript, which was self-funded by the authors. Authorship All authors attest that they meet the current ICMJE criteria for authorship. Rui Qin and Jing Ding contributed equally as co-first authors. Author Contributions Conception and design: Rui Qin, Jing Ding, Yiyun Liu and Hong Qi. Data collection, analysis and/or interpretation: Rui Qin, Jing Ding, Qianqian Lan, Yiyun Liu, Tong Sun, Linbo Bian, Dehai Liu, Xiaoyu Wang, Jiawei Chen, Zhengze Sun. Drafting the article: Rui Qin, Jing Ding. Revising it critically for important intellectual content: Hong Qi. All authors read and approved the final manuscript. Funding This study and the journal’s Rapid Service Fee were supported by the National Natural Science Foundation of China grants [Nos. 82171022, 82371026, Hong Qi] Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of Interest Rui Qin, Jing Ding, Yiyun Liu, Qianqian Lan, Tong Sun, Linbo Bian, Dehai Liu, Wenlong Li, Zhengze Sun and Hong Qi declare that they have no conflicts of interest to disclose. Ethical Approval This study complied with the principles of the Declaration of Helsinki and was approved by the Medical Science Research Ethics Committee of Peking University Third Hospital (M2023663). Written informed consent was obtained from all participants before their participation. Footnotes Rui Qin and Jing Ding have contributed equally to this work. Contributor Information Hong Qi, Email: [email protected] References Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS, Cataracts. Lancet (London England). 2017;390:600–12. Lapp T, Wacker K, Heinz C, Maier P, Eberwein P, Reinhard T. Cataract Surgery-Indications, Techniques, and Intraocular Lens Selection. Deutsches Arzteblatt Int. 2023;120:377–86. Chinese C, Refractive Surgery S. [Chinese guideline for cataract surgery in adults (2023)]. Zhonghua Yan Ke Za Zhi. 2023;59:977–87. Kane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology. 2021;128:e94–114. Jiang J, Pan X, Zhou M, Wang X, Zhu H, Li D. A comparison of IOLMaster 500 and IOLMaster 700 in the measurement of ocular biometric parameters in cataract patients. Sci Rep. 2022;12:12770. Dong S, Xu R, Wang Y, Xiao W, Jiao Y. Comparisons of biometric parameters measurements by OPD-SCAN Ⅲ and Pentacam in cataract. Photodiagn Photodyn Ther. 2024;45:103911. Xu BY, Israelsen P, Pan BX, Wang D, Jiang X, Varma R. Benefit of Measuring Anterior Segment Structures Using an Increased Number of Optical Coherence Tomography Images: The Chinese American Eye Study. Investig Ophthalmol Vis Sci. 2016;57:6313–9. Xu BY, Mai DD, Penteado RC, Saunders L, Weinreb RN. Reproducibility and Agreement of Anterior Segment Parameter Measurements Obtained Using the CASIA2 and Spectralis OCT2 Optical Coherence Tomography Devices. J Glaucoma. 2017;26:974–9. Kimura S, Morizane Y, Shiode Y, Hirano M, Doi S, Toshima S, Fujiwara A, Shiraga F. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS ONE. 2017;12:e0184066. Wang X, Chen X, Tang Y, Wang J, Chen Y, Sun X. Morphologic Features of Crystalline Lens in Patients with Primary Angle Closure Disease Observed by CASIA 2 Optical Coherence Tomography. Investig Ophthalmol Vis Sci. 2020;61:40. Melles RB, Holladay JT, Chang WJ. Accuracy of Intraocular Lens Calculation Formulas. Ophthalmology. 2018;125:169–78. Arriola-Villalobos P, Almendral-Gómez J, Garzón N, Ruiz-Medrano J, Fernández-Pérez C, Martínez-de-la-Casa JM, Díaz-Valle D. Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer. Eye. 2017;31:437–42. Kurian M, Negalur N, Das S, Puttaiah NK, Haria D, J TS, Thakkar MM. Biometry with a new swept-source optical coherence tomography biometer: Repeatability and agreement with an optical low-coherence reflectometry device. J Cataract Refract Surg. 2016;42:577–81. Foster GJL, Allen QB, Ayres BD, Devgan U, Hoffman RS, Khandelwal SS, Snyder ME, Vasavada AR, Yeoh R. Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations. J Cataract Refract Surg. 2018;44:905–16. Chen D, Tang Q, Yu F, Cai X, Lu F. Consecutive drilling combined with phaco chop for full thickness segmentation of very hard nucleus in coaxial microincisional cataract surgery. BMC Ophthalmol. 2019;19:20. Yu X, Chen W, Xu W. Diagnosis and treatment of microspherophakia. J Cataract Refract Surg. 2020;46:1674–9. Guan JY, Ma YC, Zhu YT, Xie LL, Aizezi M, Zhuo YH, Wumaier A. Lens nucleus dislocation in hypermature cataract: Case report and literature review. Medicine. 2022;101:e30428. Hirnschall N, Buehren T, Bajramovic F, Trost M, Teuber T, Findl O. Prediction of postoperative intraocular lens tilt using swept-source optical coherence tomography. J Cataract Refract Surg. 2017;43:732–6. Langenbucher A, Szentmáry N, Cayless A, Wendelstein J, Hoffmann P. Prediction of IOL decentration, tilt and axial position using anterior segment OCT data. Graefe's archive Clin experimental Ophthalmol = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2024;262:835–46. Wolffsohn JS, Davies LN, Presbyopia. Effectiveness of correction strategies. Prog Retin Eye Res. 2019;68:124–43. Popovic M, Campos-Möller X, Schlenker MB, Ahmed II. Efficacy and Safety of Femtosecond Laser-Assisted Cataract Surgery Compared with Manual Cataract Surgery: A Meta-Analysis of 14 567 Eyes. Ophthalmology. 2016;123:2113–26. Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CC. W. The Complications of Myopia: A Review and Meta-Analysis. Investig Ophthalmol Vis Sci. 2020;61:49. Lin HL, Qin YJ, Zhang YL, Zhang YQ, Niu YY, Chen YL, Hu YY, Xie WJ, Zhang HY. Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study. Journal of ophthalmology 2020, 2020 , 6974202. Muralidharan G, Martínez-Enríquez E, Birkenfeld J, Velasco-Ocana M, Pérez-Merino P, Marcos S. Morphological changes of human crystalline lens in myopia. Biomedical Opt express. 2019;10:6084–95. Lee DH, Lee HY, Lee KH, Chung KH, Joo CK. Effect of a capsular tension ring on the shape of the capsular bag and opening and the intraocular lens. J Cataract Refract Surg. 2001;27:452–6. Schartmüller D, Röggla V, Schwarzenbacher L, Meyer EL, Abela-Formanek C, Leydolt C, Menapace R. Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial. Ophthalmology 2024, 131 , 445–457. Shen L, Yang W, Li D, Wang Z, Chen W, Zhao Q, Li Y, Cui R, Liu Q. Crystalline lens decentration and tilt in eyes with different axial lengths and their associated factors. Indian J Ophthalmol. 2023;71:763–7. Gu X, Chen X, Yang G, Wang W, Xiao W, Jin G, Wang L, Dai Y, Ruan X, Liu Z, Luo L, Liu Y. Determinants of intraocular lens tilt and decentration after cataract surgery. Annals translational Med. 2020;8:921. Holladay JT, Piers PA, Koranyi G, van der Mooren M, Norrby NE. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. Journal of refractive surgery (Thorofare, N.J. : 1995) 2002, 18 , 683–691. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 19 Nov, 2024 Editor assigned by journal 15 Nov, 2024 Submission checks completed at journal 15 Nov, 2024 First submitted to journal 14 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5453837","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379933242,"identity":"3e19efd7-5f0e-4bff-bd0e-e5a5b7162591","order_by":0,"name":"Rui Qin","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Qin","suffix":""},{"id":379933243,"identity":"851e1d04-57c8-4088-a217-33e9a67e7bd6","order_by":1,"name":"Jing Ding","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Ding","suffix":""},{"id":379933244,"identity":"0d4af5c3-a80f-48fa-bff7-6f354a479fc5","order_by":2,"name":"Yiyun Liu","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Yiyun","middleName":"","lastName":"Liu","suffix":""},{"id":379933245,"identity":"88ff2b48-4540-43ac-8de9-ecf0243ea711","order_by":3,"name":"Qianqian Lan","email":"","orcid":"","institution":"Guangxi Academy of Medical Sciences, the People's Hospital of Guangxi Zhuang Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Qianqian","middleName":"","lastName":"Lan","suffix":""},{"id":379933246,"identity":"58ee0347-5a31-4362-84d4-e39bca13f39f","order_by":4,"name":"Tong Sun","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Sun","suffix":""},{"id":379933247,"identity":"bc217781-a397-41c7-83df-2190892887bd","order_by":5,"name":"Linbo Bian","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Linbo","middleName":"","lastName":"Bian","suffix":""},{"id":379933248,"identity":"6b1369cd-fd4c-43a2-b1f1-d3ff9d28b637","order_by":6,"name":"Dehai Liu","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Dehai","middleName":"","lastName":"Liu","suffix":""},{"id":379933249,"identity":"6adfae20-9d03-4f69-b2ba-c65e059ea8be","order_by":7,"name":"Xiaoyu Wang","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyu","middleName":"","lastName":"Wang","suffix":""},{"id":379933250,"identity":"b2af8dff-0493-42a1-b1b5-74b5ca79c47d","order_by":8,"name":"Jiawei Chen","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Jiawei","middleName":"","lastName":"Chen","suffix":""},{"id":379933251,"identity":"c32bc272-1d56-4ec1-bb82-2e4d21f1f022","order_by":9,"name":"Zhengze Sun","email":"","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":false,"prefix":"","firstName":"Zhengze","middleName":"","lastName":"Sun","suffix":""},{"id":379933252,"identity":"5c0fcb5a-515e-4dda-95bf-abcec593a262","order_by":10,"name":"Hong Qi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYDCCAxCKxwBEfjCwsSNGC2MDTAvjjIK0ZKK1MIC0MPN8OATh4QN8x5ufP/i4x1rGnL338GsbgwPMDOyHj27Ap0XyzDHDxhnP0nkse86lWecY3OFj4ElLu4FPi8GNHMZmngOHeYAMM+Mcg2fMDBI8ZiRosTA4zNhAihbjxwzEaAH5ZeaMA+k8BmfOmDH2GKQlsxHyCzDEHnz4cMDa3uB4j/GHH39s7PjZDx/DqwUKmEEEmwSYJEI5XAvzByJVj4JRMApGwQgDAHpsTwcitQjqAAAAAElFTkSuQmCC","orcid":"","institution":"Peking University Third Hospital, Peking University Health Science Center","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Qi","suffix":""}],"badges":[],"createdAt":"2024-11-14 12:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5453837/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5453837/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04148-y","type":"published","date":"2025-07-03T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71805999,"identity":"66955b21-a442-4fab-a0e8-8a773ff68638","added_by":"auto","created_at":"2024-12-18 17:34:14","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":232867,"visible":true,"origin":"","legend":"\u003cp\u003eA: The two-dimensional image of anterior segment captured by CASIA 2. The anterior and posterior curvature of lens (yellow lines). The lens axis (orange line) was the vertical line at the center point of lens. The vertex normal (blue line) was the line between the fixation point and the vertex of corneal topographic map.\u003c/p\u003e\n\u003cp\u003eB: The diagram showing the method of decentration and tilt of the lens. Decentration was the vertical distance from lens center to vertex normal. Tilt was the angle of lens axis against vertex normal.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/d8ca1b8d684cbeebbf68de08.jpg"},{"id":71805467,"identity":"d67fc60c-2aa0-4a4a-bb24-25266d231ea4","added_by":"auto","created_at":"2024-12-18 17:26:06","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":146982,"visible":true,"origin":"","legend":"\u003cp\u003eSlit lamp examination of the crystalline lens. A: The lens was Emery-Little I level, which was classified into G1. B: The lens was Emery-Little II level, which was classified into G2. C: The lens was Emery-Little III level, which was classified into G3. D: The lens was Emery-Little IV level, which was classified into G4.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/49ac986d1947bb8c8b53f354.jpg"},{"id":71805956,"identity":"a3b00591-7d84-4ca2-80df-29588d8f6498","added_by":"auto","created_at":"2024-12-18 17:34:06","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":82749,"visible":true,"origin":"","legend":"\u003cp\u003eComparisons of the crystalline lens parameters between lens nuclear sclerosis. A: The comparison of the curvature radius of the lens posterior surface (CRLPS). B: The comparison of the curvature radius of the lens diameter. C: The comparison of the curvature radius of the lens decentration magnitude. ** \u003cem\u003eP\u003c/em\u003e value ＜0.01. *\u003cem\u003eP\u003c/em\u003evalue ＜0.05. Differences between groups were tested with the Kruskal-Wallis test.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/cdbf84f7991d5c95c65a5768.jpg"},{"id":71805954,"identity":"5b278eb6-10cf-48e8-adf5-8dfd9136077b","added_by":"auto","created_at":"2024-12-18 17:34:06","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":32723,"visible":true,"origin":"","legend":"\u003cp\u003eComparisons of the crystalline lens between different lens nuclear sclerosis. The crystalline lenses in group G4 was performed with a smaller posterior surface curvature radius, a smaller crystalline lens diameter.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/9a528d3da05b787517dad427.jpg"},{"id":71805463,"identity":"bf7ac65c-91bd-4b5a-bf26-79fac669bf95","added_by":"auto","created_at":"2024-12-18 17:26:06","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":115918,"visible":true,"origin":"","legend":"\u003cp\u003eComparisons of the crystalline lens parameters between different AL. A: The comparison of the curvature radius of the lens anterior surface (CRLAS). B: The comparison of the curvature radius of the lens posterior surface (CRLPS). C: The comparison of the sum of CRLAS + CRLPS. D: The comparison of the curvature radius of the lens diameter. E: The comparison of the curvature radius of the lens decentration magnitude. F: The comparison of the curvature radius of the lens tilt magnitude. **\u003cem\u003eP\u003c/em\u003e value ＜0.01. *\u003cem\u003eP\u003c/em\u003e value ＜0.05. Differences between groups were tested with the Kruskal-Wallis test. The morphology of crystalline lens was performed in \u003cem\u003e\u003cstrong\u003eFigure 6\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/0bb74c576bb3db57e828f732.jpg"},{"id":71807126,"identity":"54136bb8-f885-4203-9317-7b05dc07c7b3","added_by":"auto","created_at":"2024-12-18 17:42:06","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":34962,"visible":true,"origin":"","legend":"\u003cp\u003eComparisons of the crystalline lens between group S and N\u0026amp;L. The crystalline lenses in group S was performed with a smaller anterior and posterior surfaces curvature radius, a smaller crystalline lens diameter.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/72c33d4eae68aecc46224e34.jpg"},{"id":86180266,"identity":"ac5c7713-430f-4a09-a30d-4b7cd1622a62","added_by":"auto","created_at":"2025-07-07 16:21:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1386960,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5453837/v1/f1f00724-7854-4650-9f2b-c623317a80e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphologic Features of Crystalline Lens in Age-related Cataract Patients with Different Lens Sclerosis and Axial Length","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCataract remains a leading cause of blindness worldwide. Age-related cataract is the most prevalent form of cataract among adults, typically beginning in middle to late adulthood. With advancing age, the incidence of age-related cataracts rises markedly, from 3.9% in individuals aged 55\u0026ndash;64 to 92.6% in those over 80 years of age \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. As the demographic tapestry of the world tilts towards senescence, the prevalence of age-related cataracts is poised for a marked escalation. To combat the dimming vision caused by cataracts, surgical intervention remains the sole definitive remedy. Phacoemulsification with intracapsular implantation of artificial lens stands as the most prevalent and standardized technique at present \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrior to cataract surgery, patients undergo a comprehensive preoperative assessment encompassing a detailed medical history and ophthalmic examination. Moreover, a comprehensive suite of ocular biometric measurements is essential for each patient \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Prior research has established a robust correlation between various ocular parameters \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Advancements in ocular biometry techniques have empowered ophthalmologists to gather a comprehensive array of biometric parameters during the preoperative assessment of cataract patients \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eObscured by the richly pigmented iris, a complete examination of the crystalline lens morphology remains elusive, even with pharmacologically dilated pupils. Employing a 1310 nm wavelength light source, CAISA2 (Tomey, Japan) generates a three-dimensional depiction of the anterior chamber by acquiring 128 cross-sectional images within a matter of seconds \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The device exhibits remarkable reproducibility and consistency \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Leveraging this device, recent studies have delved into the measurement of anterior segment biometric parameters, aiding ophthalmologists in their exploration of the crystalline lens tilt and decentration \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAfter excluding other possible diseases that may affect the morphological feature of the crystalline lens, we postulate that crystalline lens nuclear sclerosis and AL are potentially important factors influencing lens morphology. To date, no comprehensive study has evaluated the morphological differences of cataractous lenses with varying degrees of nuclear sclerosis and axial length. We aim to employ CAISAI2 to measure crystalline lens morphology, thereby providing a basis for individualized cataract surgery design, enhancing the safety and efficacy of the procedure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis retrospective share cross-sectional study enrolled consecutive patients scheduled for unilateral or bilateral cataract extraction with intraocular lens implantation between July 2022 and June 2023. All patients underwent a comprehensive ophthalmic and systemic medical history evaluation. We confined our observations to the left eye of the patients. This study was consistent with the Declaration of Helsinki for the use of human participants in biomedical research and received the approval of the Ethics Committee of Peking University Third Hospital (M2023663). An informed consent for participation in research was obtained from every patient.\u003c/p\u003e \u003cp\u003eThe inclusion criteria was followed: (1) Age\u0026thinsp;\u0026ge;\u0026thinsp;50 years old. (2) No restrictions of gender. (3) Definite diagnosis of age-related cataract. (4) Willingness to undergo unilateral or bilateral cataract surgery, including extracapsular cataract extraction (ECCE) or phacoemulsification. (5) Completion of preoperative anterior segment biometry measurements\u003c/p\u003e \u003cp\u003eThe exclusion criteria was followed: (1) Ophthalmic conditions as history of ocular trauma, genetic disorders causing lens ectopia or subluxation (e.g., Marfan syndrome, spherophakia and Marchesani syndrome). (2) Pseudophakic or aphakic eyes. (3) Difficulty in establishing a definitive diagnosis based on medical history, symptoms and clinical examination (4) Inability to complete essential preoperative examinations or poor quality.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative examinations\u003c/h3\u003e\n\u003cp\u003eWe recorded the patient demographics as age, gender and medical history. We recorded the anterior segment assessment: (1) Slit lamp examination to evaluate lens opacity and nuclear sclerosis. (2) IOL Master 700 (Carl Zeiss, Germany) to measure AL. (3) CASIA2 to measure crystalline lens parameters (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): curvature radius of the lens anterior surface (CRLAS), curvature radius of the lens posterior surface (CRLPS), lens thickness, lens diameter and lens tilt and decentration. Lens tilt and decentration were tested by three-dimensional result, which was converted from 32 two-dimensional results.\u003c/p\u003e \u003cp\u003eEach examination was performed by an experienced technician. Anterior segment photo data was reviewed by two researchers. For data with multiple measurements, we used image with highest quality and prioritized manual over automat ed measurements. All measurements were performed within three months before cataract surgery\u003c/p\u003e\n\u003ch3\u003eSub-Grouping\u003c/h3\u003e\n\u003cp\u003ePatients were divided into four sub-grouping by the crystalline lens nuclear sclerosis using the Emery-Little classification. The slit lamp examination was performed in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Group G1: Almost transparent, no nucleus, soft. Group G2: Nucleus is yellowish white or yellow, soft nucleus. Group G3: Nucleus is deep yellow, medium hardness nucleus. Group G4: Nucleus is brown or amber, hard nucleus. We had no Emery-Little classification grade VI patient. Another sub-grouping was based on AL. Group S: AL\u0026thinsp;\u0026le;\u0026thinsp;22.5 mm (short eyes). Group N: AL 22.5\u0026thinsp;~\u0026thinsp;25.5 mm (normal eyes). Group L: AL\u0026thinsp;\u0026ge;\u0026thinsp;25.5 mm (long eyes)\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. We compared the morphologic feature of crystalline lens in different sub-grouping.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were recorded as means and standard deviations (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), and categorical variables as counts and percentages. Statistical analysis was performed with SPSS Statistics for Windows software (version 24.0, IBM Corp.). For examination results, Kolmogorov-Smirnov test was used to verify the normal distribution. Then one-way ANOVA or Kruskal-Wallis H test was used to compare the means. For the correlation between two variables, Pearson's correlation coefficient was used if both variables were continuous and normally distributed and Spearman's correlation coefficient was used at least one variable was non-normally distributed. A P-value less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 320 eyes underwent preoperative examinations using both IOL Master 700 and CASIA2. Among these, 15 eyes were excluded due to severe crystalline lens opacity that precluded accurate AL measurement. Eight eyes were excluded due to a preoperative diagnosis of lens subluxation, six eyes due to non-age-related cataract, and six eyes due to unreliable examination results. 285 eyes (175 female and 110 male) were included in the study. The mean age of the included patients was 69.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34 years, and the mean axial length was 23.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 mm. The details of crystalline lens morphologic features for the left eyes were presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescriptive Statistics (n\u0026thinsp;=\u0026thinsp;285)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRanges\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale/male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175/110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 to 91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e69.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAxial length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.12 to 32.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLAS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.19 to 18.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLPS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.13 to 7.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.05 to 6.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.46 to 11.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecentration magnitude of the lens (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02 to 0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTilt magnitude of the lens (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3 to 10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD\u0026thinsp;=\u0026thinsp;standard deviation, CRLAS\u0026thinsp;=\u0026thinsp;curvature radius of the lens anterior surface, CRLPS\u0026thinsp;=\u0026thinsp;curvature radius of the lens posterior surface.\u003c/p\u003e \u003cp\u003eWe conducted an analysis and comparison of the morphologic features in the crystalline lenses of eyes with varying degrees of nuclear lens sclerosis. A negative correlation was observed between the CRLPS and nuclear lens sclerosis (r = -0.171, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). A negative correlation was also found between crystalline lens diameter and nuclear lens sclerosis (r = -0.143, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, a positive correlation was observed between crystalline lens decentration and nuclear lens sclerosis (r\u0026thinsp;=\u0026thinsp;0.117, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Statistically significant differences were found between the groups in terms of CRLPS, crystalline lens diameter, and crystalline lens decentration, which was presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between hardness of the crystalline lens and crystalline lens biological parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBiological Parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eEmery-Little Classification (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCorrelation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eG2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eG4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLAS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.910\u003c/p\u003e \u003cp\u003e7.48\u0026ndash;11.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003cp\u003e7.19\u0026ndash;18.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003cp\u003e7.41\u0026ndash;12.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003cp\u003e7.56\u0026ndash;10.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLPS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003cp\u003e4.87\u0026ndash;6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003cp\u003e4.33\u0026ndash;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003cp\u003e4.45\u0026ndash;7.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003cp\u003e4.13\u0026ndash;7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er= -0.171\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003cp\u003e3.80\u0026ndash;5.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003cp\u003e3.86\u0026ndash;5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003cp\u003e3.63\u0026ndash;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003cp\u003e3.05\u0026ndash;6.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.02\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.973\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003cp\u003e9.22\u0026ndash;10.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003cp\u003e8.22\u0026ndash;10.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003cp\u003e8.19\u0026ndash;11.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003cp\u003e7.46\u0026ndash;11.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er = -0.143\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecentration magnitude of the lens (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003cp\u003e0.02\u0026ndash;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003cp\u003e0.02\u0026ndash;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003cp\u003e0.02\u0026ndash;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003cp\u003e0.02\u0026ndash;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.117\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTilt magnitude of the lens (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003cp\u003e0.9\u0026ndash;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003cp\u003e0.3\u0026ndash;10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003cp\u003e1.4\u0026ndash;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003cp\u003e2.2-8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.068\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD\u0026thinsp;=\u0026thinsp;standard deviation, CRLAS\u0026thinsp;=\u0026thinsp;curvature radius of the lens anterior surface, CRLPS\u0026thinsp;=\u0026thinsp;curvature radius of the lens posterior surface. \u003csup\u003e\u003cb\u003e\u0026sect;\u003c/b\u003e\u003c/sup\u003e Differences between groups were tested with the Kruskal-Wallis test. \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e value \u0026lt;0.01. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e value \u0026lt;0.05.\u003c/p\u003e \u003cp\u003eTwo-by-two comparisons of crystalline lens parameters between each group revealed that the CRLPS of group G4 was significantly lower than that of the other three groups (G1 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, G2 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, G3 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA\u003cb\u003e)\u003c/b\u003e. Additionally, the crystalline lens diameter of group G4 was significantly smaller than that of the other three groups (G1 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, G2 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, G3 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). Conversely, the decentration magnitude of group G4 was significantly greater than that of the other three groups (G1 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, G2 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, G3 vs G4: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC). The morphology of crystalline lens was performed in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSubsequently, we conducted an analysis and comparison of the morphologic feature of the crystalline lenses in patients with varying AL. A positive correlation was observed between CRLAS and AL (r\u0026thinsp;=\u0026thinsp;0.186, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and between CRLPS and AL (r\u0026thinsp;=\u0026thinsp;0.154, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, a positive correlation was found between crystalline lens diameter and AL (r\u0026thinsp;=\u0026thinsp;0.128, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and between crystalline lens decentration magnitude and AL (r\u0026thinsp;=\u0026thinsp;0.089, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, a negative correlation was observed between crystalline lens tilt magnitude and AL (r = -0.256, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Statistically significant differences were found between the groups in terms of CRLAS, CRLPS, crystalline lens diameter, crystalline lens decentration magnitude, and crystalline lens tilt magnitude, which was presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between axial length and crystalline lens biological parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBiological Parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eAxial length\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eCorrelation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubjects (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLAS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003cp\u003e7.41\u0026ndash;18.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003cp\u003e7.19\u0026ndash;12.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003cp\u003e7.27\u0026ndash;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.186\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRLPS (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003cp\u003e4.15\u0026ndash;6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003cp\u003e4.13\u0026ndash;7.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0.53\u003c/p\u003e \u003cp\u003e4.91\u0026ndash;6.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.154\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens thickness (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003cp\u003e3.05\u0026ndash;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003cp\u003e3.40\u0026ndash;6.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003cp\u003e3.94\u0026ndash;5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er = -0.091\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLens diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003cp\u003e9.22\u0026ndash;10.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003cp\u003e8.22\u0026ndash;10.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003cp\u003e8.19\u0026ndash;11.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.128\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecentration magnitude of the lens (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003cp\u003e0.03\u0026ndash;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003cp\u003e0.02\u0026ndash;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e \u003cp\u003e0.05\u0026ndash;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.089\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTilt magnitude of the lens (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003cp\u003e2.8-8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e \u003cp\u003e1.0-10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003cp\u003e0.3\u0026ndash;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003er = -0.256\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD\u0026thinsp;=\u0026thinsp;standard deviation, CRLAS\u0026thinsp;=\u0026thinsp;curvature radius of the lens anterior surface, CRLPS\u0026thinsp;=\u0026thinsp;curvature radius of the lens posterior surface. \u003csup\u003e\u003cb\u003e\u0026sect;\u003c/b\u003e\u003c/sup\u003e Differences between groups were tested with the Kruskal-Wallis test. \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e value \u0026lt;0.01. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e value \u0026lt;0.05.\u003c/p\u003e \u003cp\u003eTwo-by-two comparisons of crystalline lens parameters between each group revealed that the CRLAS of short AL eyes was significantly lower than that of long AL eyes (S vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA). Additionally, the CRLPS of short axial eyes was significantly lower than that of normal AL and long AL eyes (S vs N: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, S vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eB\u003cem\u003e)\u003c/em\u003e. There were significant differences in the sum of CRLAS and CRLPS between groups with different axial lengths, with short AL eyes having the lowest values and long AL eyes having the highest (S vs N: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, S vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, N vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC). The crystalline lens diameter of short AL eyes was significantly smaller than that of normal AL eyes (S vs N: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eD). The crystalline lens decentration magnitude of long AL eyes was significantly greater than that of normal AL eyes (N vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eE). The crystalline lens tilt angle of long AL eyes was significantly lower than that of normal AL and short AL eyes (S vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, N vs L: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eF).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe morphologic features of crystalline lens play a pivotal role in influencing the safety and efficacy of cataract surgery. Severely opacified crystalline lenses pose significant challenges to the accurate measurement of preoperative biometric parameters \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. A significantly hardened crystalline lens, characterized by advanced nuclear sclerosis potentially renders this technique ineffective for nuclear fragmentation \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The crystalline lens tilt and decentration can serve as valuable indicators of lens dislocation, subluxation, or ectopia \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Moreover, a correlation exists between the pre-operative position of the crystalline lens and the post-operative tilt and decentration of the implanted intraocular lens (IOL). Excessive IOL tilt or decentration can negatively impact post-operative visual quality \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious research has established that the decline in accommodative capacity is attributed to a combination of diminished ciliary muscle function and increased nuclear lens sclerosis, with the latter being the primary determinant\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Hence, this study represents the first endeavor to classify the crystalline lens based on nuclear lens sclerosis severity and compare the morphologic feature of lenses across different nuclear lens sclerosis grades.\u003c/p\u003e \u003cp\u003eOur findings revealed that crystalline lenses with a smaller posterior surface curvature radius, a smaller crystalline lens diameter, and a greater crystalline lens decentration magnitude in the G4 group, which was presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. We consider that as nuclear lens sclerosis severity increases, lens opacity worsens, leading to more pronounced morphological alterations in the posterior equatorial region of the crystalline lens, which may elevate the risk of postoperative posterior capsule rupture \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The overall crystalline lens decentration magnitude was consistent with previous studies \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The greater crystalline lens decentration magnitude in the G4 group may be attributed to a combination of factors, including the smaller crystalline lens diameter, increased lens sclerosis, and ultimately, uneven tension exerted by the Zinn\u0026rsquo;s zonules.\u003c/p\u003e \u003cp\u003eRecent research suggests a correlation between axial length and the crystalline lens the morphologic features. Patients with long AL exhibit a heightened susceptibility to two prevalent forms of cataracts: nuclear and posterior subcapsular \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Patients with short AL are predisposed to primary angle-closure glaucoma episodes, which may lead to Zinn\u0026rsquo;s zonular relaxation and subsequently impact crystalline lens morphology \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Accordingly, we stratified patients based on AL and compared the morphologic features of the crystalline lens across these groups. Our findings revealed that patients with short AL exhibited CRLAS and CRLPS, as well as a reduced crystalline lens diameter. However, no significant difference in crystalline lens thickness was observed. These results indicate that the anterior and posterior surfaces of the crystalline lens in short AL eyes are more convex, as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Intriguingly, Xiaolei W et al. revealed that patients with primary angle-closure disease (PACD) exhibited smaller CRLAS of the crystalline lens and greater lens thickness \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The discovery of a thickened crystalline lens may portend as a significant risk factor for the development of PACD in patients with short AL. Our findings also reveal a notable discrepancy in the sum of CRLAS and CRLPS across varying AL. This observation suggests a potential role of the crystalline lens in \"refractive compensation\" in response to refractive errors. In emmetropic eyes, the sum is intermediate. In hyperopic eyes with a short axial length, the sum is smaller, resulting in a higher refractive power of the lens and forward convergence of light rays. Conversely, in myopic eyes with a long axial length, the sum is larger, leading to a lower refractive power of the lens and backward convergence of light rays.\u003c/p\u003e \u003cp\u003eOur findings indicate no significant difference in lens diameter between patients with long AL and those with normal AL. This observation contradicts the findings of Geethika et al., who reported a positive correlation between AL and lens diameter (r\u0026thinsp;=\u0026thinsp;0.72, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This discrepancy might be attributed to the use of isolated human lens models for lens diameter measurement in their study, along with the inclusion of young individuals without cataracts \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Accurate lens diameter measurement empowers ophthalmologists to select appropriately sized capsular tension rings for patients with zonular weakness undergoing cataract surgery \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe crystalline lens tilt and decentration in patients with long AL exhibit pronounced deviations compared to those with normal and short AL. Previous studies have also established an inverse correlation between lens tilt and AL in patients with long AL, attributing to uneven force distribution on the lens due to zonular weakness \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. We concur with the notion that the pronounced tilt and decentration observed in patients with long AL stem from uneven force distribution on the lens, rather than an enlarged capsular bag.\u003c/p\u003e \u003cp\u003eThe crystalline lens tilt and decentration are closely linked to IOL tilt and decentration following cataract surgery \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. In non-spherical IOLs, tilt magnitude exceeding 7\u0026deg; and decentration magnitude greater than 0.4 mm can compromise visual quality to a certain extent.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eLimitation\u003c/h3\u003e\n\u003cp\u003eOur study is subject to certain limitations. Firstly, while the axial length distribution of our included patients aligns with previous large-scale studies \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, the proportion of eyes with normal AL significantly exceeds that of long and short axial length subjects. Secondly, despite including only patients aged 50 and above, the residual accommodative ability in some individuals might have influenced the measurement outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn age-related cataract patients with Emery-Little classification grade IV, the posterior surface of the crystalline lens is more convex, the crystalline lens diameter is smaller, and the crystalline lens decentration is greater, compared to lower grade patients. The anterior and posterior surfaces of the crystalline lens are more convex in patients with short AL than in patients with normal AL, while patients with long AL are more likely to have greater decentration and less tilt of the crystalline lens. Therefore, preoperative assessment of the crystalline lens hardness and morphology is essential.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the participants of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical Writing/Editorial Assistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Editage for editorial assistance during the preparation of this manuscript, which was self-funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors attest that they meet the current ICMJE criteria for authorship. Rui Qin and Jing Ding contributed equally as co-first authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: Rui Qin, Jing Ding, Yiyun Liu and Hong Qi. Data collection, analysis and/or interpretation: Rui Qin, Jing Ding, Qianqian Lan, Yiyun Liu, Tong Sun, Linbo Bian, Dehai Liu, Xiaoyu Wang, Jiawei Chen, Zhengze Sun.\u0026nbsp;Drafting the article: Rui Qin, Jing Ding. Revising it critically for important intellectual content: Hong Qi. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study and the journal\u0026rsquo;s Rapid Service Fee were supported by the National Natural Science Foundation of China grants [Nos. 82171022, 82371026, Hong Qi]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRui Qin, Jing Ding, Yiyun Liu, Qianqian Lan, Tong Sun, Linbo Bian, Dehai Liu, Wenlong Li, Zhengze Sun and Hong Qi declare that they have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study complied with the principles of the Declaration of Helsinki and was approved by the Medical Science Research Ethics Committee of Peking University Third Hospital (M2023663). Written informed consent was obtained from all participants before their participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnotes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRui Qin and Jing Ding\u0026nbsp;have contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributor Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHong Qi, Email: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiu YC, Wilkins M, Kim T, Malyugin B, Mehta JS, Cataracts. Lancet (London England). 2017;390:600\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLapp T, Wacker K, Heinz C, Maier P, Eberwein P, Reinhard T. Cataract Surgery-Indications, Techniques, and Intraocular Lens Selection. Deutsches Arzteblatt Int. 2023;120:377\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChinese C, Refractive Surgery S. [Chinese guideline for cataract surgery in adults (2023)]. Zhonghua Yan Ke Za Zhi. 2023;59:977\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKane JX, Chang DF. Intraocular Lens Power Formulas, Biometry, and Intraoperative Aberrometry: A Review. Ophthalmology. 2021;128:e94\u0026ndash;114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang J, Pan X, Zhou M, Wang X, Zhu H, Li D. A comparison of IOLMaster 500 and IOLMaster 700 in the measurement of ocular biometric parameters in cataract patients. Sci Rep. 2022;12:12770.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong S, Xu R, Wang Y, Xiao W, Jiao Y. Comparisons of biometric parameters measurements by OPD-SCAN Ⅲ and Pentacam in cataract. Photodiagn Photodyn Ther. 2024;45:103911.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu BY, Israelsen P, Pan BX, Wang D, Jiang X, Varma R. Benefit of Measuring Anterior Segment Structures Using an Increased Number of Optical Coherence Tomography Images: The Chinese American Eye Study. Investig Ophthalmol Vis Sci. 2016;57:6313\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu BY, Mai DD, Penteado RC, Saunders L, Weinreb RN. Reproducibility and Agreement of Anterior Segment Parameter Measurements Obtained Using the CASIA2 and Spectralis OCT2 Optical Coherence Tomography Devices. J Glaucoma. 2017;26:974\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKimura S, Morizane Y, Shiode Y, Hirano M, Doi S, Toshima S, Fujiwara A, Shiraga F. Assessment of tilt and decentration of crystalline lens and intraocular lens relative to the corneal topographic axis using anterior segment optical coherence tomography. PLoS ONE. 2017;12:e0184066.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Chen X, Tang Y, Wang J, Chen Y, Sun X. Morphologic Features of Crystalline Lens in Patients with Primary Angle Closure Disease Observed by CASIA 2 Optical Coherence Tomography. Investig Ophthalmol Vis Sci. 2020;61:40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelles RB, Holladay JT, Chang WJ. Accuracy of Intraocular Lens Calculation Formulas. Ophthalmology. 2018;125:169\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArriola-Villalobos P, Almendral-G\u0026oacute;mez J, Garz\u0026oacute;n N, Ruiz-Medrano J, Fern\u0026aacute;ndez-P\u0026eacute;rez C, Mart\u0026iacute;nez-de-la-Casa JM, D\u0026iacute;az-Valle D. Agreement and clinical comparison between a new swept-source optical coherence tomography-based optical biometer and an optical low-coherence reflectometry biometer. Eye. 2017;31:437\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurian M, Negalur N, Das S, Puttaiah NK, Haria D, J TS, Thakkar MM. Biometry with a new swept-source optical coherence tomography biometer: Repeatability and agreement with an optical low-coherence reflectometry device. J Cataract Refract Surg. 2016;42:577\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster GJL, Allen QB, Ayres BD, Devgan U, Hoffman RS, Khandelwal SS, Snyder ME, Vasavada AR, Yeoh R. Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations. J Cataract Refract Surg. 2018;44:905\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen D, Tang Q, Yu F, Cai X, Lu F. Consecutive drilling combined with phaco chop for full thickness segmentation of very hard nucleus in coaxial microincisional cataract surgery. BMC Ophthalmol. 2019;19:20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu X, Chen W, Xu W. Diagnosis and treatment of microspherophakia. J Cataract Refract Surg. 2020;46:1674\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuan JY, Ma YC, Zhu YT, Xie LL, Aizezi M, Zhuo YH, Wumaier A. Lens nucleus dislocation in hypermature cataract: Case report and literature review. Medicine. 2022;101:e30428.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirnschall N, Buehren T, Bajramovic F, Trost M, Teuber T, Findl O. Prediction of postoperative intraocular lens tilt using swept-source optical coherence tomography. J Cataract Refract Surg. 2017;43:732\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLangenbucher A, Szentm\u0026aacute;ry N, Cayless A, Wendelstein J, Hoffmann P. Prediction of IOL decentration, tilt and axial position using anterior segment OCT data. Graefe's archive Clin experimental Ophthalmol = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2024;262:835\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolffsohn JS, Davies LN, Presbyopia. Effectiveness of correction strategies. Prog Retin Eye Res. 2019;68:124\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopovic M, Campos-M\u0026ouml;ller X, Schlenker MB, Ahmed II. Efficacy and Safety of Femtosecond Laser-Assisted Cataract Surgery Compared with Manual Cataract Surgery: A Meta-Analysis of 14 567 Eyes. Ophthalmology. 2016;123:2113\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CC. W. The Complications of Myopia: A Review and Meta-Analysis. Investig Ophthalmol Vis Sci. 2020;61:49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin HL, Qin YJ, Zhang YL, Zhang YQ, Niu YY, Chen YL, Hu YY, Xie WJ, Zhang HY. Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study. \u003cem\u003eJournal of ophthalmology\u003c/em\u003e 2020, \u003cem\u003e2020\u003c/em\u003e, 6974202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuralidharan G, Mart\u0026iacute;nez-Enr\u0026iacute;quez E, Birkenfeld J, Velasco-Ocana M, P\u0026eacute;rez-Merino P, Marcos S. Morphological changes of human crystalline lens in myopia. Biomedical Opt express. 2019;10:6084\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee DH, Lee HY, Lee KH, Chung KH, Joo CK. Effect of a capsular tension ring on the shape of the capsular bag and opening and the intraocular lens. J Cataract Refract Surg. 2001;27:452\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchartm\u0026uuml;ller D, R\u0026ouml;ggla V, Schwarzenbacher L, Meyer EL, Abela-Formanek C, Leydolt C, Menapace R. Influence of a Capsular Tension Ring on Capsular Bag Behavior of a Plate Haptic Intraocular Lens: An Intraindividual Randomized Trial. \u003cem\u003eOphthalmology\u003c/em\u003e 2024, \u003cem\u003e131\u003c/em\u003e, 445\u0026ndash;457.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen L, Yang W, Li D, Wang Z, Chen W, Zhao Q, Li Y, Cui R, Liu Q. Crystalline lens decentration and tilt in eyes with different axial lengths and their associated factors. Indian J Ophthalmol. 2023;71:763\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu X, Chen X, Yang G, Wang W, Xiao W, Jin G, Wang L, Dai Y, Ruan X, Liu Z, Luo L, Liu Y. Determinants of intraocular lens tilt and decentration after cataract surgery. Annals translational Med. 2020;8:921.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolladay JT, Piers PA, Koranyi G, van der Mooren M, Norrby NE. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. \u003cem\u003eJournal of refractive surgery (Thorofare, N.J.\u003c/em\u003e: 1995) 2002, \u003cem\u003e18\u003c/em\u003e, 683\u0026ndash;691.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Crystalline lens, Cataract, Biological parameter, Lens Sclerosis, Axial length","lastPublishedDoi":"10.21203/rs.3.rs-5453837/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5453837/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eTo evaluate the morphological features of the crystalline lens in age-related cataract patients and to report the relationship of the lens nucleus sclerosis and axial length with lens morphology.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study were reviewed of age-related cataract patients scheduled for unilateral or bilateral cataract extraction with intraocular lens (IOL) implantation between July 2022 and June 2023 at Peking University Third Hospital. Preoperative examinations were conducted using a slit lamp, IOL Master 700 (Carl Zeiss, Germany), and CAISA2 (Tomey, Japan). Patients were categorized into different subgroups based on the degree of lens nucleus sclerosis (Emery-Little classification) and the axial length (AL), and statistical analysis was performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e285 left eyes were included in the study. The mean age of the included patients was 69.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34 years, and the mean axial length was 23.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 mm. Nuclear lens sclerosis was observed to have a negative correlation with the CRLPS (r = -0.171, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and crystalline lens diameter (r = -0.143, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Conversely, nuclear lens sclerosis was observed to have a positive correlation with crystalline lens decentration (r\u0026thinsp;=\u0026thinsp;0.117, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Statistically significant differences were found in the correlation of AL with CRLAS (r\u0026thinsp;=\u0026thinsp;0.186, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), CRLPS (r\u0026thinsp;=\u0026thinsp;0.154, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), crystalline lens diameter (r\u0026thinsp;=\u0026thinsp;0.128, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), crystalline lens decentration magnitude (r\u0026thinsp;=\u0026thinsp;0.089, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and crystalline lens tilt magnitude (r = -0.256, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), respectively. There were also differences among different subgroups. The crystalline lens with Emery-Little classification IV were performed with a smaller posterior surface curvature radius, a smaller crystalline lens diameter and greater decentration than those with Emery-Little classification I-III. The crystalline lens in short AL eyes were performed with a smaller anterior and posterior surfaces curvature radius, a smaller crystalline lens diameter than these in normal and long AL eyes. The crystalline lens in long AL eyes were performed with greater lens tilt and decentration.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCrystalline lens with Emery-Little classification IV were mainly performed with abnormality in lens morphology and lens decentration. Lens with short AL were performed with abnormality in lens morphology, while that with long AL were performed with abnormality in lens decentration and tilt.\u003c/p\u003e","manuscriptTitle":"Morphologic Features of Crystalline Lens in Age-related Cataract Patients with Different Lens Sclerosis and Axial Length","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-18 17:26:01","doi":"10.21203/rs.3.rs-5453837/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-19T10:25:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-15T11:29:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-15T11:25:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-11-14T12:19:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac3f836b-8c33-446c-b327-0933756edb96","owner":[],"postedDate":"December 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:15:36+00:00","versionOfRecord":{"articleIdentity":"rs-5453837","link":"https://doi.org/10.1186/s12886-025-04148-y","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-07-03 15:58:06","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2024-12-18 17:26:01","video":"","vorDoi":"10.1186/s12886-025-04148-y","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04148-y","workflowStages":[]},"version":"v1","identity":"rs-5453837","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5453837","identity":"rs-5453837","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}