Intraocular lens (IOL) centration is pivotal in determining the visual quality and refractive success after cataract surgery, especially with premium IOLs such as multifocal, extended depth of focus (EDOF), and toric lenses. Despite the surgical and technological advancements, achieving perfect centration of the IOL remains a challenge, influenced by anatomical variations and intraoperative variables. Different preoperative variables, such as the patient's refractive status, the technique of axis marking, calculation of IOL power, IOL material and design, and measurement of visual angles, have a significant impact on the final visual outcome. Intraoperatively, following the correct surgical principles like creating a central capsulorhexis of adequate size, maintaining the zonular integrity, in-the-bag IOL placement on its planned axis, and various techniques to maintain this centration are important determinants of final optimal visual outcomes. This review intends to describe the current techniques employed for IOL centration, common challenges, and clinical outcomes. It also highlights the recent innovations that aim to improve the IOL centration accuracy and patient satisfaction.
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