Analysis and Comparison of Factors Influencing Post-Cataract Surgery Kappa Angle Changes

Analysis and Comparison of Factors Influencing Post-Cataract Surgery Kappa Angle Changes | 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 Analysis and Comparison of Factors Influencing Post-Cataract Surgery Kappa Angle Changes Bingzhen Li, Tengbo Rao, Yulin Tseng, Siyi Ma, Linhui He, Xuemin Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6994005/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 10 You are reading this latest preprint version Abstract Purpose This study aims to investigate the factors influencing changes in the kappa angle following cataract surgery. Methods A total of 95 eyes undergoing cataract surgery were included in this study. Preoperative and postoperative ocular biometric data were collected to analyze the factors influencing changes in the kappa angle after surgery. Results This study found a significant reduction in the magnitude of the kappa angle after surgery compared to the preoperative values.(14.52 ± 3.26 vs 13.45 ± 2.75, P < 0.001) The preoperative kappa angle magnitude was positively correlated with pupil size (R = 0.282, P = 0.006), axial length (R = 0.274, P = 0.009) and BK1 orientation of the posterior corneal surface (R = 0.258, P = 0.011). The postoperative kappa angle magnitude was associated with the preoperative axial length (R = 0.296, P = 0.005), pupil size (R = 0.259, P = 0.011), and preoperative kappa angle magnitude (R = 0.478, P < 0.001). The change in kappa angle magnitude was positively correlated only with the preoperative kappa angle magnitude (R = 0.623, P < 0.001). Conclusion This study explored potential factors influencing changes in kappa angle, providing some explanation for why patients with larger preoperative kappa angles may not experience optical discomfort after the implantation of multifocal intraocular lenses. angle kappa cataract multifocal IOL Figures Figure 1 Figure 2 Introduction Angle kappa is defined as the angle between the visual and pupillary axis. 1 The kappa angle plays a crucial role in refractive surgeries, particularly in cataract surgeries involving multifocal intraocular lens (IOLs) implantation. 2 Previous studies have found that photic phenomena following multifocal intraocular lens implantation are associated with the size of the preoperative kappa angle. 3 Studies have shown that a larger kappa angle is associated with an increased likelihood of photic phenomena after implanting multifocal IOLs. 4 However, some patients with a large kappa angle did not experience glare or other adverse reactions after multifocal IOLs implantation. 5 Therefore, a reduction in the kappa angle in certain cataract patients may help mitigate postoperative adverse reactions. Investigating the factors influencing changes in the kappa angle before and after cataract surgery is crucial for selecting suitable multifocal IOLs. Currently, numerous studies have analyzed the factors influencing the kappa angle in humans. Previous studies have consistently found that the size of the kappa angle decreases with an increase in axial length and decreases with advancing age and higher refractive error. 6,7 However, the kappa angle is not fixed, and numerous studies have reported that its size may change under various conditions, such as body position and pupil size. 8 Exploring other potential conditions that may cause changes in the kappa angle is of significant importance. Changes in the kappa angle after cataract surgery have already been reported. 9 Studies suggest that the white-to-white distance and axial length may be associated with changes in the kappa angle before and after cataract surgery. 10 However, there is still a lack of clinical data to support these conclusions, and the findings from different studies are not consistent. Therefore, the aim of this study is to include as many preoperative and postoperative ocular parameters of cataract patients as possible and to comprehensively analyze the factors that may influence the kappa angle. Exploring the factors that influence changes in the kappa angle before and after cataract surgery may provide valuable insights for selecting the appropriate IOL type preoperatively. Patients This prospective, non-randomized, non-comparative study was conducted following the guidelines of the Declaration of Helsinki. This study passed the ethical review of the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No.IRB00006761-M2021045). The use of all prospective data in this study was approved with informed consent obtained from all participants. A total of 95 eyes with cataracts undergoing phacoemulsification and intraocular lens (IOL) implantation were enrolled. All patients received treatment at Peking University Third Hospital between January and December 2020. Written informed consent was obtained from all participants before enrollment, and patients were informed of their right to withdraw from the study at any time. Inclusion Criteria : Lens opacity graded between C1N1P0 and C3N3P3 based on the Lens Opacities Classification System III. Total corneal astigmatism ≤ 0.75 diopters. Exclusion criteria included: (1) a history of previous intraocular surgery, (2) diagnosis of mature cataract, (3) presence of corneal or retinal pathology, (4) strabismus detected on examination, (5) diagnosis of amblyopia, (6) a traumatically mydriatic pupil during preoperative evaluation and slit-lamp examination, and (7) occurrence of intraoperative or immediate postoperative complications. Participants underwent comprehensive ophthalmologic examinations 7 days before surgery, with postoperative assessments performed at 1 day, 1 week, and 6 week post-surgery. Only data from the 42-day postoperative visit were included in the analysis. Preoperative assessments included slit-lamp biomicroscopy, uncorrected and best-corrected visual acuity, Jäger visual acuity, non-contact intraocular pressure, and measurements obtained using Pentacam. Surgical Technique Under topical anesthesia, a 3.0 mm clear corneal incision was made at the 135° axis, followed by a 5.5 mm continuous curvilinear capsulorhexis centered on the visual axis. The cataractous lens was emulsified using a phacoemulsification handpiece that employs high-frequency ultrasound waves. The lens fragments were aspirated through the same instrument, and an IOL was implanted in the capsular bag. All surgeries were uneventful, and no postoperative complications were reported. Measurement of Angle Kappa The Pentacam HR system was used by an experienced technician in a dimly lit room to measure angle kappa preoperatively and postoperatively, including both magnitude and orientation. All procedures adhered to the manufacturer’s guidelines, and no mydriatics were used before the examination. Patients were instructed to position their chins on the chin rest, foreheads against the strap, and keep their eyes open as widely as possible. If necessary, a second technician gently retracted the eyelids. Subjects were instructed to blink once and fixate on the target before scanning. Scheimpflug images passing the quality specification (QS) were deemed reliable, and data from the Cataract Pre-OP mode were analyzed. Following Sánchez-Tabernero’s vector-based approach, astigmatism was calculated to account for both magnitude and direction, providing a comprehensive evaluation. 11 △κ is defined as the preoperative kappa angle minus the postoperative kappa angle. The change in angle kappa was calculated and defined as the displacement vector (DV). Statistical Methods Statistical analysis was conducted using SPSS 23.0 software. Means and standard deviations of pupil size, aqueous depth, anterior chamber volume, anterior chamber angle, anterior chamber depth, white-to-white distance, lens thickness, and axial length were calculated. The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were employed to determine the significance of changes in the magnitude of angle kappa, anterior and posterior corneal astigmatism, aqueous depth, pupil size, anterior chamber volume, and anterior chamber angle. Pearson correlation coefficients were calculated to explore relationships between kappa angle or pupil size and other biometric parameters. A p-value of less than 0.05 was considered statistically significant. Results A total of 95 cataract-operated eyes were included in this study, comprising 38 eyes from male patients and 57 eyes from female patients. Preoperative ophthalmic parameters are summarized in Table 1 and Table 2. The comparison of ocular parameters between the preoperative and postoperative periods Table 2 and Figure 1 presents the comparison of ocular parameters between the preoperative and postoperative periods in cataract-operated eyes. Both logMAR BCVA (0.48 ± 0.51 vs 0.12 ± 0.30, P <0.001) and IOP (14.52 ± 3.26 vs 13.45 ± 2.75, P <0.001) showed a reduction postoperatively. We observed a significant reduction in the magnitude of the κ angle following cataract surgery (14.52 ± 3.26 vs 13.45 ± 2.75, P <0.001). In addition, the orientation of anterior corneal surface K1 changed (77.39 ± 58.35 vs 104.99 ± 53.48, P <0.001), while the diopter of posterior corneal surface K1 also demonstrated an upward trend after surgery (6.24 ± 0.26 vs 6.27 ± 0.28, P <0.001). Additionally, the ACA decreased postoperatively, while the AQD showed an increase following cataract surgery. No significant differences were observed between preoperative and postoperative values for the remaining parameters. Correlation analysis of the preoperative and postoperative kappa angle and its change. Figure 2 illustrates the changes in the distribution of the kappa angle between the preoperative and postoperative periods in cataract-operated eyes. Table 2 presents the correlation between the kappa angle and related ocular structural parameters. We found that the preoperative kappa angle was positively correlated with both the preoperative (R = 0.274，P = 0.007) and postoperative pupil size (R = 0.282，P = 0.006), as well as with the orientation of the posterior corneal surface K1 (R = 0.258，P = 0.011). Additionally, axial length also demonstrated a positive correlation with the preoperative kappa angle magnitude (R = 0.274，P = 0.009). The postoperative kappa angle was positively correlated with the preoperative pupil size (R = 0.259，P = 0.011), preoperative AL (R = 0.296，P = 0.005) and also with the preoperative kappa angle (R = 0.478，P < 0.001). Regarding the change in the kappa angle, we found a positive correlation with the preoperative kappa angle (R = 0.623，P < 0.001), and a negative correlation with the postoperative kappa angle (R = -0.390，P < 0.001). For DV, we found that it was only associated with the preoperative kappa angle (R = 0.489，P < 0.001). Baseline Factor Analysis of Kappa Angle Reduction Based on whether the postoperative kappa angle decreased, all patients were classified into the Kappa Angle Increase Group and the Kappa Angle Reduction Group. We found that the baseline kappa magnitude was relatively larger in the group where the kappa angle decreased postoperatively (0.29 ± 0.16 vs 0.17 ± 0.13, P <0.001). Additionally, patients with a larger baseline BK2 were more likely to exhibit a reduction in the kappa angle (6.55 ± 0.27 vs 6.44 ± 0.25, P <0.001). Additionally, no significant differences were observed between the two groups for other baseline factors. Discussion At present, there are relatively few studies on the factors influencing changes in the kappa angle following cataract phacoemulsification surgery. The kappa angle represents the angle between the visual axis and the center of the pupil. Previous studies have confirmed that the halos and glare phenomena produced by the implantation of mIOLs are related to the kappa angle. 5 The occurrence of this phenomenon is primarily due to the fact that patients with a larger kappa angle may have their central light more closely aligned with the peripheral region of the IOL, leading to halos and glare. However, in actual clinical practice, some patients with a large kappa angle do not experience optical discomfort. Recent studies have also found that using the kappa angle alone to evaluate postoperative visual quality after mIOL implantation is insufficient. 12 Our study found that preoperative kappa angle size is primarily associated with preoperative axial length and pupil size. The relationship between pupil size and kappa angle changes may be due to an uneven distribution of forces in the iris sphincter muscle, leading to alterations in the kappa angle. 13 However, the relationship between kappa angle and axial length remains uncertain. Previous studies from Korea have reported a negative correlation between kappa angle and axial length. 14 Meanwhile, some literature suggests that the relationship between kappa angle and axial length may have a threshold effect. 15 Therefore, the relationship between kappa angle and axial length may require more detailed stratified matching in order to be further elucidated. In this study, we observed a reduction in the kappa angle following cataract surgery, which is consistent with the findings of previous studies. 9 The reasons for this change have not yet been fully elucidated. On one hand, it may be attributed to the surgery itself, which could alter the position, shape, or size of the pupil. In our study, we observed a trend toward a reduction in pupil size; however, no significant difference was identified in this process. Perhaps when the sample size is expanded, this difference may become more apparent. Previous studies have confirmed a positive correlation between pupil size and kappa angle size. 16 This may help explain the reasons behind the postoperative changes in the kappa angle. Secondly, our study also revealed changes in the anterior and posterior corneal surface K1 following cataract surgery. This may lead to changes in the visual axis, thereby contributing to alterations in the kappa angle. Our study found that the most significant factor influencing changes in the kappa angle was the preoperative kappa angle size. The larger the preoperative kappa angle, the greater the change in the kappa angle, which is a finding not reported in previous related studies. This partly explains why some patients with larger preoperative kappa angles did not experience significant optical side effects after multifocal intraocular lens implantation in previous studies. 5 It may be due to a reduction in the kappa angle size following cataract surgery. This may suggest that for some patients with larger kappa angles who may have optical function needs, slightly relaxing the criteria for multifocal IOLs implantation could be feasible. Additionally, we found that patients who experienced a reduction in kappa angle may have larger BK2 diopters, which has not been reported previously. This suggests that clinicians should exercise more caution when selecting mIOLs for patients with smaller BK2 diopters. In previous studies, the WTW distance has been the only parameter identified as potentially associated with the magnitude of kappa angle changes. 10 However, in our study, no influence of the WTW distance on the kappa angle was observed. Previous studies have suggested that a shorter WTW distance is associated with a larger kappa angle. 15 Additionally, our study did not find a relationship between kappa angle changes and WTW-related parameters such as ACD. 15 Therefore, using WTW to predict postoperative kappa angle changes may still require further research and validation. This study still has some limitations. On one hand, the sample size in this study is relatively small. Future studies with larger sample sizes may help clarify the relationship between some controversial parameters, such as WTW, and changes in the kappa angle. On the other hand, this study only measured the factors influencing changes in the kappa angle preoperatively and postoperatively, without correlating these changes with the patients' visual quality. This provides a new direction for future research. Conclusion This study highlights the significant reduction in kappa angle magnitude following cataract surgery and identifies key factors influencing both preoperative and postoperative kappa angle magnitudes. Preoperative kappa angle magnitude was positively correlated with pupil size, axial length, and the BK1 orientation of the posterior corneal surface, while postoperative kappa angle magnitude was associated with preoperative axial length, pupil size, and preoperative kappa angle magnitude. The change in kappa angle magnitude was primarily influenced by the preoperative kappa angle magnitude. These findings provide valuable insights into the dynamics of kappa angle changes and support the clinical observation that patients with larger preoperative kappa angles may tolerate multifocal intraocular lenses without significant optical discomfort. Declarations Acknowledgments: None. Ethics approval and consent to participate: This prospective, non-randomized, non-comparative study was conducted following the guidelines of the Declaration of Helsinki. This study passed the ethical review of the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No.IRB00006761-M2021045). The use of all prospective data in this study was approved with informed consent obtained from all participants. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests:None. Funding: None. Authors' contributions: Bingzhen Li was responsible for the study design and manuscript drafting; Tengbo Rao and Yulin Tseng contributed to manuscript writing and data analysis; Siyi Ma and Linhui He were responsible for data collection, and Xuemin Li oversaw the revision and proofreading of the manuscript. Acknowledgements: None. References Moshirfar M, Hoggan RN, Muthappan V. Angle Kappa and its importance in refractive surgery. Oman J Ophthalmol. 2013;6(3):151–8. Park CY, Oh SY, Chuck RS. Measurement of angle kappa and centration in refractive surgery. Curr Opin Ophthalmol. 2012;23(4):269–75. Karhanová M, Marešová K, Pluháček F, Mlčák P, Vláčil O, Sín M. The importance of angle kappa for centration of multifocal intraocular lenses. Cesk Slov Oftalmol. 2013;69(2):64–8. Qi Y, Lin J, Leng L, et al. Role of angle κ in visual quality in patients with a trifocal diffractive intraocular lens. J Cataract Refract Surg. 2018;44(8):949–54. Prakash G, Prakash DR, Agarwal A, Kumar DA, Agarwal A, Jacob S. Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation. Eye (Lond). 2011;25(9):1187–93. Gharaee H, Shafiee M, Hoseini R, Abrishami M, Abrishami Y, Abrishami M. Angle Kappa Measurements: Normal Values in Healthy Iranian Population Obtained With the Orbscan II. Iran Red Crescent Med J. 2015;17(1):e17873. Schaeffel F. Kappa and Hirschberg ratio measured with an automated video gaze tracker. Optom Vis Sci. 2002;79(5):329–34. Qi H, Jiang J-J, Jiang Y-M, Wang L-Q, Huang Y-F. Kappa angles in different positions in patients with myopia during LASIK. Int J Ophthalmol. 2016;9(4):585–9. Wang R, Long T, Gu X, Ma T. Changes in angle kappa and angle alpha before and after cataract surgery. J Cataract Refract Surg. 2020;46(3):365–71. Umesh Y, Saolapurkar K, Joshi P, Singh D. Measurement of change in angle kappa and its correlation with ocular biometric parameters pre- and post-phacoemulsification. Indian J Ophthalmol. 2023;71(2):535–40. Sánchez-Tabernero S. SIA-formula: an easy way to calculate surgically induced astigmatism. Eye (Lond). 2018;32(3):659–60. Wallerstein A, Ridgway C, Gatinel D, et al. Angle Kappa Influence on Multifocal IOL Outcomes. J Refract Surg. 2023;39(12):840–9. Deng W-Q, Fang Y-H, Lin S-H, Li Y-J. Dynamic distribution and correlation analysis of the angle kappa in myopia patients undergoing femtosecond-assisted laser in situ keratomileusis. Med (Baltim). 2022;101(24):e29425. Choi SR, Kim US. The correlation between angle kappa and ocular biometry in Koreans. Korean J Ophthalmol. 2013;27(6):421–4. Meng J, Du Y, Wei L, et al. Distribution of angle α and angle κ in a population with cataract in Shanghai. J Cataract Refract Surg. 2021;47(5):579–84. Yang Y, Thompson K, Burns SA. Pupil location under mesopic, photopic, and pharmacologically dilated conditions. Invest Ophthalmol Vis Sci. 2002;43(7):2508–12. Tables Variable Age (y) 69.97 ± 9.60 Gender male 38 female 57 Eye type OD 43 OS 52 Logmar BCVA 0.48 ± 0.50 IOP (mmHg) 14.48 ± 3.26 Pupil (mm) 2.84 ± 0.65 AL (mm) 23.84 ± 1.83 LT (mm) 4.61 ± 0.58 WTW (mm) 11.63 ± 4.32 ACD (mm) 2.91 ± 0.48 Table 1. Baseline demographics of Pre-Cataract Surgery Patients. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length. Variable Preoperative Postoperative P Logmar BCVA 0.48 ± 0.51 0.12 ± 0.30 <0.001*** IOP (mmHg) 14.52 ± 3.26 13.45 ± 2.75 <0.001*** Pupil (mm) 2.85 ± 0.65 2.77 ± 0.61 0.196 κ Magnitude (mm) 0.25 ± 0.16 0.20 ± 0.14 0.003** κ Orientation (°) 176.00 ± 111.43 172.01 ± 102.46 0.737 K1 (Diopter) 43.78 ± 1.64 43.41 ± 4.35 0.376 K1 Orientation (°) 77.39 ± 58.35 104.99 ± 53.48 <0.001*** K2 (Diopter) 44.28 ± 1.70 43.87 ± 4.41 0.33 BK1 (Diopter) 6.24 ± 0.26 6.27 ± 0.28 0.001** BKI Orientation (°) 119.28 ± 74.87 102.49 ± 77.92 0.104 BK2 (Diopter) 6.51 ± 0.27 6.53 ± 0.28 0.117 ACA (°) 30.22 ± 7.38 42.28 ± 5.11 <0.001*** AQD (mm) 2.46 ± 0.47 3.93 ± 0.77 <0.001*** Table 2. Comparison of Preoperative and Postoperative Ocular Structural Parameters. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. * P <0.05, ** P <0.01, and *** P <0.001. Preoperative κ Magnitude Postoperative κ Magnitude △κ (magnitude) DV R P R P R P R P Preoperative Pupil 0.274 0.007** 0.259 0.011* 0.056 0.588 0.175 0.09 AL 0.274 0.009** 0.296 0.005* 0.012 0.910 -0.045 0.665 LT 0.144 0.176 0.176 0.097 -0.006 0.952 0.091 0.395 WTW -0.047 0.657 0.030 0.780 -0.076 0.474 -0.092 0.389 κ Magnitude / / 0.478 <0.001*** 0.623 <0.001*** 0.489 <0.001*** κ Orientation -0.129 0.211 -0.17 0.099 0.016 0.877 0.043 0.677 K1 Diopter 0.009 0.932 0.034 0.744 -0.021 0.84 0.032 0.762 K1 Orientation 0.159 0.123 0.182 0.077 0.005 0.963 0.103 0.32 K2 Diopter 0.023 0.827 0.042 0.685 -0.014 0.895 0.046 0.66 BK1 Diopter -0.029 0.78 -0.007 0.949 -0.024 0.814 -0.003 0.979 BKI Orientation 0.258 0.011* 0.112 0.281 0.171 0.097 0.024 0.82 BK2 Diopter -0.054 0.602 -0.022 0.829 -0.037 0.724 -0.064 0.535 AQD -0.044 0.671 -0.145 0.162 0.083 0.426 0.101 0.329 ACD -0.076 0.475 -0.115 0.280 0.023 0.829 0.069 0.516 ACV -0.036 0.728 -0.126 0.224 0.074 0.475 0.093 0.371 ACA -0.069 0.504 -0.121 0.242 0.035 0.735 0.101 0.328 Postoperative Pupil 0.282 0.006** 0.147 0.154 0.164 0.112 0.097 0.348 κ Magnitude 0.478 <0.001*** / / -0.390 <0.001*** 0.09 0.385 κ Orientation -0.021 0.840 -0.141 0.174 0.103 0.319 -0.024 0.82 K1 Diopter 0.095 0.360 0.067 0.519 0.040 0.701 0.033 0.748 K1 Orientation -0.057 0.583 0.028 0.791 -0.084 0.417 -0.033 0.752 K2 Diopter 0.1 0.337 0.076 0.462 0.036 0.726 0.037 0.722 BK1 Diopter -0.033 0.753 -0.029 0.778 -0.008 0.937 -0.041 0.696 BKI Orientation -0.006 0.955 -0.075 0.473 0.060 0.562 -0.041 0.693 BK2 Diopter -0.023 0.822 0.018 0.860 -0.041 0.695 -0.085 0.415 AQD 0.092 0.385 0.059 0.577 0.044 0.677 0.068 0.519 ACV -0.042 0.689 -0.056 0.592 0.006 0.954 0.049 0.635 ACA -0.12 0.251 -0.072 0.488 -0.065 0.536 0.062 0.555 Variation ΔPupil -0.009 0.934 -0.127 0.222 0.104 0.317 -0.088 0.398 ΔACD 0.099 0.349 0.143 0.172 -0.024 0.82 -0.004 0.967 ΔACV 0.012 0.909 0.132 0.202 -0.105 0.31 -0.089 0.392 ΔACA -0.017 0.874 0.116 0.266 -0.12 0.25 -0.075 0.475 Table 3. Correlation Analysis Between Changes in Kappa Angle and Ocular Structural Parameters. ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. * P <0.05, ** P <0.01, and *** P <0.001. Variable κ Reduction Group κ Increase Group P Logmar BCVA 0.45 ± 0.47 0.55 ± 0.58 0.392 IOP (mmHg) 14.55 ± 2.89 14.37 ± 3.92 0.805 Pupil (mm) 2.83 ± 0.58 2.88 ± 0.77 0.701 κ Magnitude (mm) 0.29 ± 0.16 0.17 ± 0.13 <0.001*** κ Orientation (°) 182.08 ± 106.58 165.08 ± 120.50 0.479 K1 (Diopter) 43.95 ± 1.73 43.47 ± 1.43 0.167 K1 Orientation (°) 76.60 ± 58.42 78.80 ± 59.09 0.861 K2 (Diopter) 44.52 ± 1.72 43.86 ± 1.61 0.071 BK1 (Diopter) 6.27 ± 0.27 6.17 ± 0.24 0.059 BKI Orientation (°) 125.24 ± 71.94 108.60 ± 79.84 0.302 BK2 (Diopter) 6.55 ± 0.27 6.44 ± 0.25 0.046* AQD (mm) 2.45 ± 0.45 2.46 ± 0.52 0.945 ACA (°) 30.44 ± 6.90 29.92 ± 8.19 0.746 AL (mm) 23.66 ± 1.86 24.15 ± 1.76 0.220 ACD (mm) 2.90 ± 0.44 2.93 ± 0.54 0.832 LT (mm) 4.60 ± 0.60 4.64 ± 0.57 0.795 WTW (mm) 115.38 ± 54.91 118.00 ± 4.58 0.782 Table 4. Baseline Factor Analysis of Kappa Angle Reduction. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. * P <0.05, ** P <0.01, and *** P <0.001. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Nov, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 25 Aug, 2025 Reviews received at journal 22 Aug, 2025 Reviews received at journal 09 Aug, 2025 Reviewers agreed at journal 09 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers invited by journal 29 Jul, 2025 Editor assigned by journal 28 Jul, 2025 Editor invited by journal 07 Jul, 2025 Submission checks completed at journal 07 Jul, 2025 First submitted to journal 07 Jul, 2025 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. 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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-6994005","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493273733,"identity":"6150cb21-9636-4338-bd5c-07a50275cdd1","order_by":0,"name":"Bingzhen Li","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bingzhen","middleName":"","lastName":"Li","suffix":""},{"id":493273734,"identity":"d2df1cb7-4bec-44d8-85d2-c1514060a5da","order_by":1,"name":"Tengbo Rao","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tengbo","middleName":"","lastName":"Rao","suffix":""},{"id":493273735,"identity":"26cd6fec-ce75-4a8d-af11-f28342d78a03","order_by":2,"name":"Yulin Tseng","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yulin","middleName":"","lastName":"Tseng","suffix":""},{"id":493273737,"identity":"2ee9f0b4-1c7e-4c9d-a3d0-ba9b0525cba6","order_by":3,"name":"Siyi Ma","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Siyi","middleName":"","lastName":"Ma","suffix":""},{"id":493273738,"identity":"d4a52ed8-3db1-4749-9eac-5d24c0eae0e4","order_by":4,"name":"Linhui He","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Linhui","middleName":"","lastName":"He","suffix":""},{"id":493273740,"identity":"18a3f4c4-b693-4188-bf73-03d93dc8cbd5","order_by":5,"name":"Xuemin Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACPgYGxgMMDDZy/AyMDcRpYQNioJY0Y8kGErUcSjQ4QKzD2CSyEw7z5hxIMD5/uO3BDwY7OV1ClrHxnN1wcOa2O3lmNxLbDXsYko3NCFnHxt674cDHbc+KzW4wtknwMBxI3EZQCzPvBqCyw4mb+w+2Sf4hSgvElsOJGxgS26SJswXilzRjiRtALTIGRPiFXyJ342PebcCo7D/+TPJNhZ0cQS1owIA05aNgFIyCUTAKcAAAi4BFsBVddi4AAAAASUVORK5CYII=","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xuemin","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-06-27 19:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6994005/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6994005/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04431-y","type":"published","date":"2025-11-07T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88099607,"identity":"68d9f902-bff5-40eb-a909-0d3bcfefab69","added_by":"auto","created_at":"2025-08-01 11:17:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":194121,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Preoperative and Postoperative Ocular Structural Parameters. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACA anterior chamber angle; AQD aqueous depth. *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, and ***\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6994005/v1/0bcc5d3928c1e4d606257d86.jpg"},{"id":88098399,"identity":"f38fc06a-882d-4557-b9c8-0c690f93f84b","added_by":"auto","created_at":"2025-08-01 11:09:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":234294,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of angle kappa. A and B: Preoperative and postoperative angle kappa for both left and right eyes. C and D: Preoperative and postoperative angle kappa for the right eye. E and F: Preoperative and postoperative angle kappa of the left eye.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6994005/v1/97f252956031e693b91153a9.jpg"},{"id":95563998,"identity":"a5eb8e15-7ff7-4579-a194-9541fdcf12cf","added_by":"auto","created_at":"2025-11-10 16:06:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1364107,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6994005/v1/c0f0f411-0257-4241-9b2c-557020b0c61b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis and Comparison of Factors Influencing Post-Cataract Surgery Kappa Angle Changes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAngle kappa is defined as the angle between the visual and pupillary axis.\u003csup\u003e1\u003c/sup\u003e The kappa angle plays a crucial role in refractive surgeries, particularly in cataract surgeries involving multifocal intraocular lens (IOLs) implantation.\u003csup\u003e2\u003c/sup\u003e Previous studies have found that photic phenomena following multifocal intraocular lens implantation are associated with the size of the preoperative kappa angle. \u003csup\u003e3\u003c/sup\u003e Studies have shown that a larger kappa angle is associated with an increased likelihood of photic phenomena after implanting multifocal IOLs.\u003csup\u003e4\u003c/sup\u003e However, some patients with a large kappa angle did not experience glare or other adverse reactions after multifocal IOLs implantation.\u003csup\u003e5\u003c/sup\u003e Therefore, a reduction in the kappa angle in certain cataract patients may help mitigate postoperative adverse reactions. Investigating the factors influencing changes in the kappa angle before and after cataract surgery is crucial for selecting suitable multifocal IOLs.\u003c/p\u003e\n\u003cp\u003eCurrently, numerous studies have analyzed the factors influencing the kappa angle in humans. Previous studies have consistently found that the size of the kappa angle decreases with an increase in axial length and decreases with advancing age and higher refractive error.\u003csup\u003e6,7\u003c/sup\u003e However, the kappa angle is not fixed, and numerous studies have reported that its size may change under various conditions, such as body position and pupil size.\u003csup\u003e8\u003c/sup\u003e Exploring other potential conditions that may cause changes in the kappa angle is of significant importance.\u003c/p\u003e\n\u003cp\u003eChanges in the kappa angle after cataract surgery have already been reported.\u003csup\u003e9\u003c/sup\u003e Studies suggest that the white-to-white distance and axial length may be associated with changes in the kappa angle before and after cataract surgery.\u003csup\u003e10\u003c/sup\u003e However, there is still a lack of clinical data to support these conclusions, and the findings from different studies are not consistent. Therefore, the aim of this study is to include as many preoperative and postoperative ocular parameters of cataract patients as possible and to comprehensively analyze the factors that may influence the kappa angle. Exploring the factors that influence changes in the kappa angle before and after cataract surgery may provide valuable insights for selecting the appropriate IOL type preoperatively.\u003c/p\u003e"},{"header":"Patients","content":"\u003cp\u003eThis prospective, non-randomized, non-comparative study was conducted following the guidelines of the Declaration of Helsinki. This study passed the ethical review of the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No.IRB00006761-M2021045). The use of all prospective data in this study was approved with informed consent obtained from all participants. A total of 95 eyes with cataracts undergoing phacoemulsification and intraocular lens (IOL) implantation were enrolled. All patients received treatment at Peking University Third Hospital between January and December 2020. Written informed consent was obtained from all participants before enrollment, and patients were informed of their right to withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eLens opacity graded between C1N1P0 and C3N3P3 based on the Lens Opacities Classification System III.\u003c/li\u003e\n \u003cli\u003eTotal corneal astigmatism ≤ 0.75 diopters.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria included: (1) a history of previous intraocular surgery, (2) diagnosis of mature cataract, (3) presence of corneal or retinal pathology, (4) strabismus detected on examination, (5) diagnosis of amblyopia, (6) a traumatically mydriatic pupil during preoperative evaluation and slit-lamp examination, and (7) occurrence of intraoperative or immediate postoperative complications.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants underwent comprehensive ophthalmologic examinations 7 days before surgery, with postoperative assessments performed at 1 day, 1 week, and 6 week post-surgery. Only data from the 42-day postoperative visit were included in the analysis. Preoperative assessments included slit-lamp biomicroscopy, uncorrected and best-corrected visual acuity, Jäger visual acuity, non-contact intraocular pressure, and measurements obtained using Pentacam.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Under topical anesthesia, a 3.0 mm clear corneal incision was made at the 135° axis, followed by a 5.5 mm continuous curvilinear capsulorhexis centered on the visual axis. The cataractous lens was emulsified using a phacoemulsification handpiece that employs high-frequency ultrasound waves. The lens fragments were aspirated through the same instrument, and an IOL was implanted in the capsular bag. All surgeries were uneventful, and no postoperative complications were reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasurement of Angle Kappa\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The Pentacam HR system was used by an experienced technician in a dimly lit room to measure angle kappa preoperatively and postoperatively, including both magnitude and orientation. All procedures adhered to the manufacturer’s guidelines, and no mydriatics were used before the examination.\u003c/p\u003e\n\u003cp\u003ePatients were instructed to position their chins on the chin rest, foreheads against the strap, and keep their eyes open as widely as possible. If necessary, a second technician gently retracted the eyelids. Subjects were instructed to blink once and fixate on the target before scanning.\u003c/p\u003e\n\u003cp\u003eScheimpflug images passing the quality specification (QS) were deemed reliable, and data from the Cataract Pre-OP mode were analyzed. Following Sánchez-Tabernero’s vector-based approach, astigmatism was calculated to account for both magnitude and direction, providing a comprehensive evaluation.\u003csup\u003e11\u003c/sup\u003e △κ is defined as the preoperative kappa angle minus the postoperative kappa angle.\u0026nbsp;The change in angle kappa was calculated and defined as the displacement vector (DV).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Methods\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Statistical analysis was conducted using SPSS 23.0 software. Means and standard deviations of pupil size, aqueous depth, anterior chamber volume, anterior chamber angle, anterior chamber depth, white-to-white distance, lens thickness, and axial length were calculated. The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were employed to determine the significance of changes in the magnitude of angle kappa, anterior and posterior corneal astigmatism, aqueous depth, pupil size, anterior chamber volume, and anterior chamber angle. Pearson correlation coefficients were calculated to explore relationships between kappa angle or pupil size and other biometric parameters. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 95 cataract-operated eyes were included in this study, comprising 38 eyes from male patients and 57 eyes from female patients. Preoperative ophthalmic parameters are summarized in Table 1 and Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe comparison of ocular parameters between the preoperative and postoperative periods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 and Figure 1 presents the comparison of ocular parameters between the preoperative and postoperative periods in cataract-operated eyes. Both logMAR BCVA (0.48 ± 0.51 vs 0.12 ± 0.30, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) and IOP (14.52 ± 3.26 vs 13.45 ± 2.75, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) showed a reduction postoperatively. We observed a significant reduction in the magnitude of the κ angle following cataract surgery (14.52 ± 3.26 vs 13.45 ± 2.75, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). In addition, the orientation of anterior corneal surface K1 changed (77.39 ± 58.35 vs 104.99 ± 53.48, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), while the diopter of posterior corneal surface K1 also demonstrated an upward trend after surgery (6.24 ± 0.26 vs 6.27 ± 0.28, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Additionally, the ACA decreased postoperatively, while the AQD showed an increase following cataract surgery. No significant differences were observed between preoperative and postoperative values for the remaining parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation analysis of the preoperative and postoperative kappa angle and its change.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 illustrates the changes in the distribution of the kappa angle between the preoperative and postoperative periods in cataract-operated eyes. Table 2 presents the correlation between the kappa angle and related ocular structural parameters. We found that the preoperative kappa angle was positively correlated with both the preoperative (R = 0.274，P = 0.007) and postoperative pupil size (R = 0.282，P = 0.006), as well as with the orientation of the posterior corneal surface K1 (R = 0.258，P = 0.011). Additionally, axial length also demonstrated a positive correlation with the preoperative kappa angle magnitude (R = 0.274，P = 0.009). The postoperative kappa angle was positively correlated with the preoperative pupil size (R = 0.259，P = 0.011), preoperative AL \u0026nbsp;(R = 0.296，P = 0.005) and also with the preoperative kappa angle (R = 0.478，P \u0026lt; 0.001). Regarding the change in the kappa angle, we found a positive correlation with the preoperative kappa angle (R = 0.623，P \u0026lt; 0.001), and a negative correlation with the postoperative kappa angle (R = -0.390，P \u0026lt; 0.001). For DV, we found that it was only associated with the preoperative kappa angle (R = 0.489，P \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Factor Analysis of Kappa Angle Reduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on whether the postoperative kappa angle decreased, all patients were classified into the Kappa Angle Increase Group and the Kappa Angle Reduction Group. We found that the baseline kappa magnitude was relatively larger in the group where the kappa angle decreased postoperatively (0.29 ± 0.16 vs 0.17 ± 0.13, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Additionally, patients with a larger baseline BK2 were more likely to exhibit a reduction in the kappa angle (6.55 ± 0.27 vs 6.44 ± 0.25, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Additionally, no significant differences were observed between the two groups for other baseline factors.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt present, there are relatively few studies on the factors influencing changes in the kappa angle following cataract phacoemulsification surgery. The kappa angle represents the angle between the visual axis and the center of the pupil. Previous studies have confirmed that the halos and glare phenomena produced by the implantation of mIOLs are related to the kappa angle.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The occurrence of this phenomenon is primarily due to the fact that patients with a larger kappa angle may have their central light more closely aligned with the peripheral region of the IOL, leading to halos and glare. However, in actual clinical practice, some patients with a large kappa angle do not experience optical discomfort. Recent studies have also found that using the kappa angle alone to evaluate postoperative visual quality after mIOL implantation is insufficient.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOur study found that preoperative kappa angle size is primarily associated with preoperative axial length and pupil size. The relationship between pupil size and kappa angle changes may be due to an uneven distribution of forces in the iris sphincter muscle, leading to alterations in the kappa angle.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e However, the relationship between kappa angle and axial length remains uncertain. Previous studies from Korea have reported a negative correlation between kappa angle and axial length.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Meanwhile, some literature suggests that the relationship between kappa angle and axial length may have a threshold effect.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Therefore, the relationship between kappa angle and axial length may require more detailed stratified matching in order to be further elucidated.\u003c/p\u003e\u003cp\u003eIn this study, we observed a reduction in the kappa angle following cataract surgery, which is consistent with the findings of previous studies.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The reasons for this change have not yet been fully elucidated. On one hand, it may be attributed to the surgery itself, which could alter the position, shape, or size of the pupil. In our study, we observed a trend toward a reduction in pupil size; however, no significant difference was identified in this process. Perhaps when the sample size is expanded, this difference may become more apparent. Previous studies have confirmed a positive correlation between pupil size and kappa angle size.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This may help explain the reasons behind the postoperative changes in the kappa angle. Secondly, our study also revealed changes in the anterior and posterior corneal surface K1 following cataract surgery. This may lead to changes in the visual axis, thereby contributing to alterations in the kappa angle.\u003c/p\u003e\u003cp\u003eOur study found that the most significant factor influencing changes in the kappa angle was the preoperative kappa angle size. The larger the preoperative kappa angle, the greater the change in the kappa angle, which is a finding not reported in previous related studies. This partly explains why some patients with larger preoperative kappa angles did not experience significant optical side effects after multifocal intraocular lens implantation in previous studies.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e It may be due to a reduction in the kappa angle size following cataract surgery. This may suggest that for some patients with larger kappa angles who may have optical function needs, slightly relaxing the criteria for multifocal IOLs implantation could be feasible. Additionally, we found that patients who experienced a reduction in kappa angle may have larger BK2 diopters, which has not been reported previously. This suggests that clinicians should exercise more caution when selecting mIOLs for patients with smaller BK2 diopters.\u003c/p\u003e\u003cp\u003eIn previous studies, the WTW distance has been the only parameter identified as potentially associated with the magnitude of kappa angle changes.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e However, in our study, no influence of the WTW distance on the kappa angle was observed. Previous studies have suggested that a shorter WTW distance is associated with a larger kappa angle.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Additionally, our study did not find a relationship between kappa angle changes and WTW-related parameters such as ACD.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Therefore, using WTW to predict postoperative kappa angle changes may still require further research and validation.\u003c/p\u003e\u003cp\u003eThis study still has some limitations. On one hand, the sample size in this study is relatively small. Future studies with larger sample sizes may help clarify the relationship between some controversial parameters, such as WTW, and changes in the kappa angle. On the other hand, this study only measured the factors influencing changes in the kappa angle preoperatively and postoperatively, without correlating these changes with the patients' visual quality. This provides a new direction for future research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the significant reduction in kappa angle magnitude following cataract surgery and identifies key factors influencing both preoperative and postoperative kappa angle magnitudes. Preoperative kappa angle magnitude was positively correlated with pupil size, axial length, and the BK1 orientation of the posterior corneal surface, while postoperative kappa angle magnitude was associated with preoperative axial length, pupil size, and preoperative kappa angle magnitude. The change in kappa angle magnitude was primarily influenced by the preoperative kappa angle magnitude. These findings provide valuable insights into the dynamics of kappa angle changes and support the clinical observation that patients with larger preoperative kappa angles may tolerate multifocal intraocular lenses without significant optical discomfort.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: This prospective, non-randomized, non-comparative study was conducted following the guidelines of the Declaration of Helsinki. This study passed the ethical review of the Peking University Third Hospital Medical Science Research Ethics Committee (Approval No.IRB00006761-M2021045). The use of all prospective data in this study was approved with informed consent obtained from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:None.\u003c/p\u003e\n\u003cp\u003eFunding: None.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: Bingzhen Li was responsible for the study design and manuscript drafting; Tengbo Rao and Yulin Tseng contributed to manuscript writing and data analysis; Siyi Ma and Linhui He were responsible for data collection, and Xuemin Li oversaw the revision and proofreading of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoshirfar M, Hoggan RN, Muthappan V. Angle Kappa and its importance in refractive surgery. Oman J Ophthalmol. 2013;6(3):151\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark CY, Oh SY, Chuck RS. Measurement of angle kappa and centration in refractive surgery. Curr Opin Ophthalmol. 2012;23(4):269\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarhanov\u0026aacute; M, Marešov\u0026aacute; K, Pluh\u0026aacute;ček F, Mlč\u0026aacute;k P, Vl\u0026aacute;čil O, S\u0026iacute;n M. The importance of angle kappa for centration of multifocal intraocular lenses. Cesk Slov Oftalmol. 2013;69(2):64\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQi Y, Lin J, Leng L, et al. Role of angle κ in visual quality in patients with a trifocal diffractive intraocular lens. J Cataract Refract Surg. 2018;44(8):949\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrakash G, Prakash DR, Agarwal A, Kumar DA, Agarwal A, Jacob S. Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation. Eye (Lond). 2011;25(9):1187\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGharaee H, Shafiee M, Hoseini R, Abrishami M, Abrishami Y, Abrishami M. Angle Kappa Measurements: Normal Values in Healthy Iranian Population Obtained With the Orbscan II. Iran Red Crescent Med J. 2015;17(1):e17873.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchaeffel F. Kappa and Hirschberg ratio measured with an automated video gaze tracker. Optom Vis Sci. 2002;79(5):329\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQi H, Jiang J-J, Jiang Y-M, Wang L-Q, Huang Y-F. Kappa angles in different positions in patients with myopia during LASIK. Int J Ophthalmol. 2016;9(4):585\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang R, Long T, Gu X, Ma T. Changes in angle kappa and angle alpha before and after cataract surgery. J Cataract Refract Surg. 2020;46(3):365\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUmesh Y, Saolapurkar K, Joshi P, Singh D. Measurement of change in angle kappa and its correlation with ocular biometric parameters pre- and post-phacoemulsification. Indian J Ophthalmol. 2023;71(2):535\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS\u0026aacute;nchez-Tabernero S. SIA-formula: an easy way to calculate surgically induced astigmatism. Eye (Lond). 2018;32(3):659\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWallerstein A, Ridgway C, Gatinel D, et al. Angle Kappa Influence on Multifocal IOL Outcomes. J Refract Surg. 2023;39(12):840\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeng W-Q, Fang Y-H, Lin S-H, Li Y-J. Dynamic distribution and correlation analysis of the angle kappa in myopia patients undergoing femtosecond-assisted laser in situ keratomileusis. Med (Baltim). 2022;101(24):e29425.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoi SR, Kim US. The correlation between angle kappa and ocular biometry in Koreans. Korean J Ophthalmol. 2013;27(6):421\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMeng J, Du Y, Wei L, et al. Distribution of angle α and angle κ in a population with cataract in Shanghai. J Cataract Refract Surg. 2021;47(5):579\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang Y, Thompson K, Burns SA. Pupil location under mesopic, photopic, and pharmacologically dilated conditions. Invest Ophthalmol Vis Sci. 2002;43(7):2508\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"349\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAge (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e69.97 \u0026plusmn; 9.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eEye type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003eOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003eOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eLogmar BCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e0.48 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eIOP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e14.48 \u0026plusmn; 3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003ePupil (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e2.84 \u0026plusmn; 0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eAL (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e23.84 \u0026plusmn; 1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eLT (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e4.61 \u0026plusmn; 0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eWTW (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e11.63 \u0026plusmn; 4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 108px;\"\u003e\n \u003cp\u003eACD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e2.91 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1. Baseline demographics of Pre-Cataract Surgery Patients. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length.\u0026nbsp;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"478\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eLogmar BCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e0.48 \u0026plusmn; 0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.12 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eIOP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e14.52 \u0026plusmn; 3.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e13.45 \u0026plusmn; 2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003ePupil (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e2.85 \u0026plusmn; 0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e2.77 \u0026plusmn; 0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026kappa; Magnitude (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e0.25 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e0.20 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026kappa; Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e176.00 \u0026plusmn; 111.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e172.01 \u0026plusmn; 102.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eK1 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e43.78 \u0026plusmn; 1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e43.41 \u0026plusmn; 4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eK1 Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e77.39 \u0026plusmn; 58.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e104.99 \u0026plusmn; 53.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eK2 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e44.28 \u0026plusmn; 1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e43.87 \u0026plusmn; 4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBK1 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e6.24 \u0026plusmn; 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e6.27 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBKI Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e119.28 \u0026plusmn; 74.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e102.49 \u0026plusmn; 77.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eBK2 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e6.51 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e6.53 \u0026plusmn; 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eACA (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e30.22 \u0026plusmn; 7.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e42.28 \u0026plusmn; 5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003eAQD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e2.46 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e3.93 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2. Comparison of Preoperative and Postoperative Ocular Structural Parameters. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, and ***\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003ePreoperative \u0026kappa; Magnitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 129px;\"\u003e\n \u003cp\u003ePostoperative \u0026kappa; Magnitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e△\u0026kappa; (magnitude)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003eDV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"16\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePupil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.007**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.009**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.005*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWTW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026kappa; Magnitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026kappa; Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK1 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK1 Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK2 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBK1 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBKI Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBK2 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eACD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eACV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eACA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePupil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.006**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026kappa; Magnitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e/\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e/\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026kappa; Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.840\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK1 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.360\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK1 Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eK2 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBK1 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBKI Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBK2 Diopter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.860\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAQD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eACV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eACA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003eVariation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;Pupil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;ACD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.967\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;ACV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026Delta;ACA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 3. Correlation Analysis Between Changes in Kappa Angle and Ocular Structural Parameters. ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, and ***\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"473\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026kappa; Reduction Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026kappa; Increase Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eLogmar BCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e0.45 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0.55 \u0026plusmn; 0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eIOP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e14.55 \u0026plusmn; 2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e14.37 \u0026plusmn; 3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003ePupil (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e2.83 \u0026plusmn; 0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2.88 \u0026plusmn; 0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026kappa; Magnitude (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e0.29 \u0026plusmn; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e0.17 \u0026plusmn; 0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026lt;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026kappa; Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e182.08 \u0026plusmn; 106.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e165.08 \u0026plusmn; 120.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eK1 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e43.95 \u0026plusmn; 1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e43.47 \u0026plusmn; 1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eK1 Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e76.60 \u0026plusmn; 58.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e78.80 \u0026plusmn; 59.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eK2 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e44.52 \u0026plusmn; 1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e43.86 \u0026plusmn; 1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eBK1 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e6.27 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e6.17 \u0026plusmn; 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eBKI Orientation (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e125.24 \u0026plusmn; 71.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e108.60 \u0026plusmn; 79.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eBK2 (Diopter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e6.55 \u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e6.44 \u0026plusmn; 0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.046*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAQD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e2.45 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2.46 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.945\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eACA (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e30.44 \u0026plusmn; 6.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e29.92 \u0026plusmn; 8.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAL (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e23.66 \u0026plusmn; 1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e24.15 \u0026plusmn; 1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.220\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eACD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e2.90 \u0026plusmn; 0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e2.93 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eLT (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e4.60 \u0026plusmn; 0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e4.64 \u0026plusmn; 0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eWTW (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e115.38 \u0026plusmn; 54.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e118.00 \u0026plusmn; 4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4. Baseline Factor Analysis of Kappa Angle Reduction. BCVA best corrected visual acuity; IOP Intraocular Pressure; ACD anterior chamber depth; WTW white to white; LT lens thickness; AL axial length; ACV anterior chamber volume; ACA anterior chamber angle; AQD aqueous depth. *\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01, and ***\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001.\u003c/p\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":"angle kappa, cataract, multifocal IOL","lastPublishedDoi":"10.21203/rs.3.rs-6994005/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6994005/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aims to investigate the factors influencing changes in the kappa angle following cataract surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 95 eyes undergoing cataract surgery were included in this study. Preoperative and postoperative ocular biometric data were collected to analyze the factors influencing changes in the kappa angle after surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThis study found a significant reduction in the magnitude of the kappa angle after surgery compared to the preoperative values.(14.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26 vs 13.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) The preoperative kappa angle magnitude was positively correlated with pupil size (R\u0026thinsp;=\u0026thinsp;0.282, P\u0026thinsp;=\u0026thinsp;0.006), axial length (R\u0026thinsp;=\u0026thinsp;0.274, P\u0026thinsp;=\u0026thinsp;0.009) and BK1 orientation of the posterior corneal surface (R\u0026thinsp;=\u0026thinsp;0.258, P\u0026thinsp;=\u0026thinsp;0.011). The postoperative kappa angle magnitude was associated with the preoperative axial length (R\u0026thinsp;=\u0026thinsp;0.296, P\u0026thinsp;=\u0026thinsp;0.005), pupil size (R\u0026thinsp;=\u0026thinsp;0.259, P\u0026thinsp;=\u0026thinsp;0.011), and preoperative kappa angle magnitude (R\u0026thinsp;=\u0026thinsp;0.478, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The change in kappa angle magnitude was positively correlated only with the preoperative kappa angle magnitude (R\u0026thinsp;=\u0026thinsp;0.623, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study explored potential factors influencing changes in kappa angle, providing some explanation for why patients with larger preoperative kappa angles may not experience optical discomfort after the implantation of multifocal intraocular lenses.\u003c/p\u003e","manuscriptTitle":"Analysis and Comparison of Factors Influencing Post-Cataract Surgery Kappa Angle Changes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 11:09:00","doi":"10.21203/rs.3.rs-6994005/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-25T08:51:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-22T20:48:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-09T12:54:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14760392726712875618648749000645530535","date":"2025-08-09T08:00:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108888529254675139400921065621120338431","date":"2025-08-06T20:12:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T19:10:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T17:32:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-07T10:33:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-07T08:16:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-07-07T08:13:35+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":"640c7592-6001-4130-b34e-f07c79f27416","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T16:01:04+00:00","versionOfRecord":{"articleIdentity":"rs-6994005","link":"https://doi.org/10.1186/s12886-025-04431-y","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-11-07 15:57:32","publishedOnDateReadable":"November 7th, 2025"},"versionCreatedAt":"2025-08-01 11:09:00","video":"","vorDoi":"10.1186/s12886-025-04431-y","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04431-y","workflowStages":[]},"version":"v1","identity":"rs-6994005","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6994005","identity":"rs-6994005","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}