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Influencing factors of effective lens position in patients with Marfan syndrome and ectopia lentis
  1. Xin Shen,
  2. Zexu Chen,
  3. WanNan Jia,
  4. Yalei Wang,
  5. Tianhui Chen,
  6. Yang Sun,
  7. Yongxiang Jiang
  1. Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
  1. Correspondence to Professor Yongxiang Jiang, Department of Ophthalmology, Fudan University, Shanghai, China; yongxiang_jiang{at}


Aims The aim of this study was to analyse the effective lens position (ELP) in patients with Marfan syndrome (MFS) and ectopia lentis (EL).

Methods Patients with MFS undergoing lens removal and primary intraocular lens (IOL) implantation were enrolled in the study. The back-calculated ELP was obtained with the vergence formula and compared with the theoretical ELPs. The back-calculated ELP and ELP error were evaluated among demographic and biometric parameters, including axial length (AL), corneal curvature radius (CCR) and white-to-white (WTW).

Results A total of 292 eyes from 200 patients were included. The back-calculated ELP was lower in patients undergoing scleral-fixated IOL than those receiving in-the-bag IOL implantation (4.54 (IQR 3.65–5.20) mm vs 4.98 (IQR 4.56–5.67) mm, p<0.001). The theoretical ELP of the SRK/T formula exhibited the highest accuracy, with no difference from the back-calculated ELP in patients undergoing in-the-bag IOL implantation (5.11 (IQR 4.83–5.65) mm vs 4.98 (IQR 4.56–5.67) mm, p=0.209). The ELP errors demonstrated significant correlations with refraction prediction error (PE): a 1 mm ELP error led to PE of 2.42D (AL<22 mm), 1.47D (22 mm≤AL<26 mm) and 0.54D (AL≥26 mm). Multivariate analysis revealed significant correlations of ELP with AL (b=0.43, p<0.001), CCR (b=−0.85, p<0.001) and WTW (b=0.41, p=0.004).

Conclusion This study provides novel insights into the origin of PE in patients with MFS and EL and potentially refines existing formulas.

  • Phakic Intraocular Lenses
  • Optics and Refraction

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • XS and ZC are joint first authors.

  • XS and ZC contributed equally.

  • Contributors YJ, XS and ZC were responsible for the research design of this article. XS, TC, YS and W-NJ collected the clinical data for congenital EL patients. XS and ZC were responsible for statistical analyses. YW provided critical suggestions. YJ supervised the whole project and has taken responsibility for the work. XS and ZC contributed equally to this work. All authors in this study reviewed and revised the final manuscript.

  • Funding This study was supported by the National Natural Science Foundation of China (grant nos. 82271068 and 82070943) and the Shanghai Science and Technology Commission (Scientific Innovation Action Plan, grant nos. 22Y11910400 and 20Y11911000).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.