Traumatic cataract and other adverse events with the implantable contact lens

All about traumatic cataracts: narrative review

Ocular trauma is an important cause of monocular blindness worldwide. Injury to the lens after blunt or penetrating trauma is common and can result in vision impairment. Selecting the most appropriate therapeutic approaches depends on factors such as patients' age, mechanism of trauma, and underlying clinical conditions. Early management, especially within childhood, is essential because of the difficulties involved in examination; anatomical variations; as well as accompanying intraocular inflammation, amblyopia, or vitreoretinal adhesions. The objective of this study was to provide a comprehensive review of the epidemiology and clinical management of traumatic cataract, highlighting the significance of accurate diagnosis and selection of the optimal therapeutic approach.

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review

Myopia is the leading cause of visual impairment in the world. With ever-increasing prevalence in these years, it creates an alarming global epidemic. In addition to the difficulty in seeing distant objects, myopia also increases the risk of cataract and advances its onset, greatly affecting the productivity of myopes of working age. Cataract management in myopic eyes, especially highly myopic eyes is originally more complicated than that in normal eyes, whereas the growing population of cataract with myopia, increasing popularity of corneal and lens based refractive surgery, and rising demand for spectacle independence after cataract surgery all further pose unprecedented challenges to ophthalmologists. Previous history of corneal refractive surgery and existence of implantable collamer lens will both affect the accuracy of biometry including measurement of corneal curvature and axial length before cataract surgery, which may result in larger intraocular lens (IOL) power prediction errors and a compromise in the surgical outcome especially in a refractive cataract surgery. A prudent choice of formula for cataract patients with different characteristics is essential in improving this condition. Besides, the characteristics of myopic eyes might affect the long-term stability of IOL, which is important for the maintenance of visual outcomes especially after the implantation of premium IOLs, thus a proper selection of IOL accordingly is crucial. In this mini-review, we provide an overview of the impact of myopia epidemic on treatment for cataract and to discuss new challenges that surgeons may encounter in the foreseeable future when planning refractive cataract surgery for myopic patients.

Corneal diameter measurements by 3 optical biometers and their effect on phakic intraocular lens sizing

PURPOSE

To compare phakic intraocular lens size calculations based on corneal diameter (CD) measurements by 3 instruments.

SETTING

G.B. Bietti Foundation I.R.C.C.S., Rome, Italy.

DESIGN

Retrospective interventional case series.

METHODS

Preoperatively, CD was measured with the Aladdin, IOLMaster 700, and Pentacam AXL Wave. The simulated ICL size was computed by entering CD measurements into the manufacturer's calculator. Postoperatively, vaulting was measured by anterior segment optical coherence tomography. The optimal ICL size (OIS) was calculated and compared with the commercially available OIS (CAOIS).

RESULTS

54 eyes (29 patients) with the implantable collamer lens (ICL) were enrolled. The mean CD was 12.02 ± 0.36 mm with the Aladdin, 12.35 ± 0.39 mm with the IOLMaster 700, and 12.22 ± 0.41 mm with the Pentacam AXL Wave ( P < .0001), with the closest agreement between the Pentacam AXL Wave and IOLMaster 700 (95% limits of agreement: -0.43 to +0.17 mm). Vaulting (mean: 558 ± 261 μm) was within 251 and 1000 μm in 49 eyes (83.3%). The mean difference between the simulated ICL size and OIS ranged between -0.11 ± 0.35 mm and 0.10 ± 0.30 mm ( P < .0001), with no statistically significant difference between the IOLMaster 700 and Pentacam AXL Wave. The simulated ICL size was equal to CAOIS in 38 eyes (70.37%) with the Aladdin, 37 eyes (68.52%) with the IOLMaster 700, and 39 eyes (72.22%) with the Pentacam AXL Wave, without any statistically significant difference.

CONCLUSIONS

CD measurements by the 3 devices lead to similar percentages of eyes with an ICL size equal to the OIS. Agreement is closer between the IOLMaster 700 and Pentacam AXL Wave.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

PURPOSE

To introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL.

METHODS

We searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years.

RESULTS

ICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications.

CONCLUSION

There are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.

Intentional Undercorrection by Implantation of Posterior Chamber Phakic Intraocular Lens With A Central Hole (Hole ICL) For Early Presbyopia

Purpose

To assess visual performance at near to far distances in early presbyopic patients with undercorrection by implantation of an ICL with a central hole (hole ICL).

Methods

This prospective study evaluated forty-two eyes of 21 early presbyopic patients (age, 40 to 53 years) with spherical equivalents of -7.37 ± 3.18 D [mean ± standard deviation] who underwent hole ICL implantation and whose targeted refraction was set at slight myopia (-0.61 ± 0.28 D) for both eyes. We assessed the safety, efficacy at near to far distances, predictability, and adverse events of the surgery, during the 6-month observation period.

Results

Corrected distance visual acuity did not improve significantly, from -0.17 ± 0.07 preoperatively to -0.19 ± 0.08 logMAR postoperatively (p=0.066, Wilcoxon signed-rank test). Uncorrected distance visual acuity was significantly improved from 1.30 ± 0.24 preoperatively to -0.03 ± 0.20 logMAR postoperatively (p<0.001). The mean binocular visual acuity was 0.02 logMAR or better at all distances (5.0, 3.0, 2.0, 1.0, 0.7, 0.5, and 0.3 m). All eyes were within ± 0.5 D of the targeted correction. Neither cataract formation, significant intraocular pressure rise, nor other vision-threatening complications occurred in any case during the 6-month observation period.

Conclusions

Our pilot study showed that intentional undercorrection by hole ICL implantation for early presbyopia was safe with predictable refractive results and provided good binocular vision at near to far distances, without developing cataract, suggesting its viability as a surgical presbyopic treatment for such patients.

Monovision by Implantation of Posterior Chamber Phakic Intraocular Lens with a Central Hole (Hole ICL) for Early Presbyopia

This study was aimed to evaluate visual performance at near to far distances in early presbyopic patients undergoing monovision by implantation of an ICL with a central hole (hole ICL). This pilot study comprised thirty-four eyes of 17 early presbyopic patients (age, 40 to 53 years) who underwent hole ICL implantation, and whose targeted refraction was set at emmetropia for the dominant eye, and at slight myopia (-0.5 to -1.0 diopters (D)) for the non-dominant eye. Corrected distance visual acuity was significantly improved, from -0.11 ± 0.07 preoperatively to -0.19 ± 0.09 logMAR postoperatively (p < 0.001, Wilcoxon signed-rank test). Uncorrected distance visual acuity was also significantly improved from 1.43 ± 0.35 preoperatively to -0.04 ± 0.18 logMAR postoperatively (p < 0.001). The mean binocular visual acuity was 0.01 logMAR or better at all distances (5.0, 3.0, 2.0, 1.0, 0.7, 0.5, and 0.3 m). All eyes were within ± 0.5 D of the targeted correction. All patients had within the normal range of near stereopsis. Neither cataract formation, significant intraocular pressure rise, nor vision-threatening complications occurred. Monovision by hole ICL implantation provided good binocular vision at near to far distances, without developing cataract, suggesting its feasibility as a new surgical presbyopic approach for early presbyopia.

Comparison of Implantable Collamer Lens Visian ICL V4 and ICL V4c for high myopia: A cohort study

The aim of this study was to investigate the visual quality of the 2 kinds of intraocular lens: Visian implantable collamer lens (ICL) V4 and Visian ICL V4c implantations for high myopia.Twenty cases (20 eyes) with high myopia who received Visian ICL V4 implantation and 18 cases (18 eyes) with high myopia who received Visian ICL V4c implantation in our hospital from April 1, 2014 to November 31, 2016 were enrolled. In 1-month follow-up, near vision, best corrected distant visual acuity (BCVA), uncorrected distant visual acuity (UDVA), and wavefront aberrations were measured, and compensation factor was calculated.Near vision, UDVA, and BCVA showed no significant difference between ICL V4 implantation and ICL V4c implantation (P >.05). However, high-order aberrations and spherical aberrations were higher in ICL V4c implantation than in ICL V4 implantation (P <.05). Low-order aberrations (defocus and astigmatism), coma, and subjective visual quality had no significant difference between ICL V4 implantation and ICL V4c implantation (P >.05).The 2 kinds of ICL Visian ICL V4 and Visian ICL V4c had similar efficacy of visual quality for high myopia. The presence of the central hole of Visian ICL V4c has no significant effect on visual quality.

A prospective comparison of phakic collamer lenses and wavefront-optimized laser-assisted in situ keratomileusis for correction of myopia

PURPOSE

The aim of this study was to evaluate and compare night vision and low-luminance contrast sensitivity (CS) in patients undergoing implantation of phakic collamer lenses or wavefront-optimized laser-assisted in situ keratomileusis (LASIK).

PATIENTS AND METHODS

This is a nonrandomized, prospective study, in which 48 military personnel were recruited. Rabin Super Vision Test was used to compare the visual acuity and CS of Visian implantable collamer lens (ICL) and LASIK groups under normal and low light conditions, using a filter for simulated vision through night vision goggles.

RESULTS

Preoperative mean spherical equivalent was -6.10 D in the ICL group and -6.04 D in the LASIK group (P=0.863). Three months postoperatively, super vision acuity (SVa), super vision acuity with (low-luminance) goggles (SVaG), super vision contrast (SVc), and super vision contrast with (low luminance) goggles (SVcG) significantly improved in the ICL and LASIK groups (P<0.001). Mean improvement in SVaG at 3 months postoperatively was statistically significantly greater in the ICL group than in the LASIK group (mean change [logarithm of the minimum angle of resolution, LogMAR]: ICL =-0.134, LASIK =-0.085; P=0.032). Mean improvements in SVc and SVcG were also statistically significantly greater in the ICL group than in the LASIK group (SVc mean change [logarithm of the CS, LogCS]: ICL =0.356, LASIK =0.209; P=0.018 and SVcG mean change [LogCS]: ICL =0.390, LASIK =0.259; P=0.024). Mean improvement in SVa at 3 months was comparable in both groups (P=0.154).

CONCLUSION

Simulated night vision improved with both ICL implantation and wavefront-optimized LASIK, but improvements were significantly greater with ICLs. These differences may be important in a military setting and may also affect satisfaction with civilian vision correction.

Visual Outcome of Traumatic Cataract at a Tertiary Eye Care Centre in North India: A Prospective Study

INTRODUCTION

One of the most common presentations of blunt and penetrating ocular trauma is traumatic cataract. It remains a significant cause of visual impairment and physical disability among adults and children. It is associated with various ocular injuries.

AIM

To evaluate the associated ocular injuries and final outcome of patients with traumatic cataract along with their demographic features and modes of trauma.

MATERIALS AND METHODS

A prospective study done in Department of Ophthalmology in M.L.B. Medical college, Jhansi from February 2010 to July 2011. A total of 48 patients diagnosed as a case of traumatic cataract were subjected to a detailed history, systemic and local examination with relevant investigations. Medical or surgical managements were done accordingly. Patients were subsequently followed-up and visual acuity was recorded. Appropriate statistical tests were applied.

RESULTS

A 54.2% patients sustained penetrating trauma while 45.8% got blunt injury. Out of total, 79% patients were males while 50% were less than 15 years of age. Causative agents were stone, wood items, stick, metal objects etc. Among blunt trauma cases, 64% of the patients had visual acuity <6/60 while among penetrating trauma cases nobody had acuity >6/18. Anterior segment was more involved as compared to posterior segment. A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of >6/18.

CONCLUSION

This study provides recent data of patients hospitalized after ocular trauma and diagnosed as a case of traumatic cataract. Traumatic cataract occurs mostly in younger males. Surgical intervention is necessary to improve visual outcome. Good visual outcome was obtained in nearly half of the patients. Traumatic cataract patients can have good visual outcome depending upon proper management.

Prevalence of cataract after collagen copolymer phakic intraocular lens implantation for myopia, hyperopia, and astigmatism

PURPOSE

To evaluate the prevalence of cataract after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation with different models at different ages and for different refractive powers.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

DESIGN

Retrospective nonrandomized clinical study.

METHODS

The pIOL (models V4, V4b, or V4c) was implanted in all cases.

RESULTS

The study included 3420 eyes (1898 patients). The mean patient age at surgery was 31.2 years ± 6.4 (SD) (range 18 to 50 years) and the mean spherical refractive error, -7.27 ± 5.24 diopters (D) (range -26.5 to 12.5 D). Twenty-one eyes (0.61%) of 15 patients had pIOL explantation (all model V4) because cataract developed. The mean age of the patients who had explantation was 39.43 ± 4.57 years; 7 were younger than 40 years, and 8 were 40 years or older. The mean spherical equivalent was -10.1 ± 5.41 D; 3 eyes had a pIOL power less than -10.50 D, 4 eyes between -10.50 D and -13.50 D, and 14 higher than -13.50 D. The mean time between pIOL implantation and cataract surgery was 4.2 ± 1.8 years. No eye with implantation of the latest models (V4b and V4c) developed cataract. The mean vault distance in eyes that developed cataracts was 103 ± 69 μm.

CONCLUSIONS

The incidence of cataract was low after pIOL implantation at the 6-year follow-up. The rate of cataract was higher in older patients and in those with high refractive errors.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Implantable collamer lens versus iris-fixed phakic intraocular lens implantation to correct myopia: a meta-analysis

This study is a meta-analysis comparing the efficacy, predictability, and safety of correcting myopia via implantation of two types of phakic intraocular lens (PIOLs): the implantable collamer lens (ICL) and iris-fixed PIOL. The Cochrane library, Pubmed, and EMBASE were searched. Study selection, data exclusion, and quality assessment were performed by two independent observers. The pooled relative risk (RR), pooled standardized mean difference (SMD), and their 95% confidence intervals (CIs) were used to compare lenses. Seven studies, involving 511 eyes, were included. The pooled SMD in postoperative uncorrected distance visual acuity (UDVA) comparing ICLs to iris-fixed PIOLs was −0.22 (95% CI, −0.58 to 0.13; P = .22). The pooled RR values of UDVA of 20/20 or better and of 20/40 or better comparing ICLs to iris-fixed PIOLs were 1.15 (95% CI, 0.89 to 1.47; P = .29) and 1.01 (95% CI, 0.95 to 1.08; P = .75), respectively. The pooled RR of loss of best spectacle-corrected visual acuity (BSCVA) and gain in BSCVA comparing ICLs to iris-fixed PIOLs were 1.20 (95% CI, 0.24 to 6.00; P = .82) and 1.14 (95% CI, 0.89 to 1.48; P = .31), respectively. The pooled RR comparing ICLs to iris-fixed PIOLs was 0.78 (95% CI, 0.29 to 2.12; P = .63) for all reported complications and 2.80 (95% CI, 1.04 to 7.52; P = .04) for severe complications. The pooled RR of achieving a result within ±0.5 D (diopter) of the intended target comparing ICLs to iris-fixed PIOLs was 1.35 (95% CI, 1.04 to 1.77; P = .03). Overall, there is no significant difference in efficacy between the two types of PIOLs or in safety, except that the ICL is associated with a greater incidence of severe complications, especially anterior subcapsular cataract, primarily in the Version 2 and Version 3 groups. However, ICL has better predictability.

Eight-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia

PURPOSE

To assess the long-term clinical outcomes of Implantable Collamer Lens (Visian ICL; STAAR Surgical) implantation for moderate to high myopia.

DESIGN

Retrospective observational case series.

METHODS

This study evaluated 41 eyes of 41 patients with myopic refractive errors of -4.00 to -15.25 diopters (D) who underwent ICL implantation and routine postoperative examinations. Before surgery, and 1 and 6 months and 1, 4 and 8 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery.

RESULTS

The safety and efficacy indices were 1.13 ± 0.27 and 0.83 ± 0.36. At 8 years, 68.3% and 85.4% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.32 ± 0.73 D occurred between 1 month and 8 years. The mean endothelial cell loss from preoperative levels was 6.2% at 8 years. Two eyes (4.9%) developed clinically significant symptomatic cataract during the follow-up period. Simultaneous lens extraction and phacoemulsification with IOL implantation was successfully performed in these 2 eyes.

CONCLUSIONS

According to our experience, ICL implantation was overall good in measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopia during the 8-year observation period, suggesting its long-term viability as a surgical option for the treatment of such eyes.

Anterior segment variations after posterior chamber phakic intraocular lens implantation in myopic eyes

PURPOSE

To evaluate anterior segment variations after posterior chamber phakic intraocular lens (pIOL) implantation in myopic eyes.

SETTING

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

DESIGN

Cohort study.

METHODS

Patients with high myopia were scheduled for nontoric Implantable Collamer Lens pIOL or toric Implantable Collamer Lens pIOL implantation. Anterior segment optical coherence tomography was performed to evaluate the anterior segment variations over time and the impact of physiologic accommodation and change in brightness after pIOL implantation. Slitlamp photography of the anterior segment was taken after pupil dilation to calculate pIOL rotation.

RESULTS

There was significantly improved visual acuity and refractive status after implantation of both pIOLs. Anterior segment axial variations had good stability 6 months postoperatively. However, nontoric pIOL rotation occurred in 1 eye 7 months postoperatively and rotation of the toric pIOL occurred in 2 eyes at 3 months and 6 months. Stimulations of -4.0 diopters (D) and -8.0 D led to significant changes in anterior chamber depth (ACD) based on the lens (ACD-lens), ACD after pIOL implantation, distance between the pIOL posterior surface and the lens anterior surface (pIOL-lens), and pupil diameter. Increasing ambient light brightness could reduce the ACD-lens and pIOL-lens.

CONCLUSIONS

Both pIOLs had good axial stability in myopic eyes 6 months postoperatively; however, rotational stability over time could not be determined. The physiologic adjustment and change in brightness could influence the anterior segment significantly in eyes with a pIOL.

Viscocannula-assisted reinversion of implantable collamer lens: comparison of postoperative outcomes with the fellow eyes

PURPOSE

To analyze and compare the postoperative outcomes of eyes with accidental intraoperative inversion of implantable collamer lens (ICL) and viscocannula-assisted reinversion in high myopia.

DESIGN

Retrospective observational case comparison.

METHODS

SETTING

Institutional practice.

PATIENTS

Consecutive eyes with accidental intraoperative inversion of ICL and viscocannula-assisted reinversion from January 2007 to September 2010 were analyzed retrospectively. They were compared with the fellow eyes with normal ICL implantation at 1 month, 6 months, and 2 years.

MAIN OUTCOME MEASURES

Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal pachymetry, endothelial cell loss, intraocular pressure, lens transparency, anterior chamber depth, and postoperative uveitis.

RESULTS

A total of 206 myopic eyes had ICL implantation. Eight eyes (3.8%) of 8 patients had accidental intraoperative reinversion. Their fellow eyes had normal ICL implantation. There was no significant change (P = .611) in UCVA (reinverted and fellow eyes) at 2 years. There was no significant difference in postoperative UCVA (P = .611) and BCVA (P = .854) between the reinverted and the fellow eyes. The mean endothelial loss at 1 month, 6 months, and 2 years was 0.96% ± 0.5%, 0.92% ± 0.63%, and 0.89% ± 0.52% respectively in the reinverted eyes. There was no significant difference in the endothelial loss between the 2 groups at 1 month (P = .753), 6 months (P = .834), and 2 years (P = .916). One out of 8 eyes with reinversion had postoperative corneal edema, which resolved at 48 hours. None of the eyes reported uveitis or glaucoma. There was no loss of lens transparency.

CONCLUSION

Intraoperative inversion can occur during insertion of ICL and viscocannula-assisted reinversion can be performed without significant complications.

Implantable collamer posterior chamber intraocular lenses: a review of potential complications

PURPOSE

To review the peer-reviewed literature reporting postoperative complications of the most recent models of Visian Implantable Collamer posterior chamber intraocular lenses (ICL, STAAR Surgical Co).

METHODS

A literature search of the PubMed database was performed to identify all articles related to ICL complications. Articles were obtained and reviewed to identify those that reported complications using the latest ICL designs.

RESULTS

Cataract was the major postoperative complication reported: 136 (5.2%) in 2592 eyes. Of those, 43.4% (n=59) were reported within 1 year, 15.4% (n=21) between 1 and 3 years, and 35.3% (n=48) ≥ 3 years after ICL implantation. Twenty-one (15.4%) cataracts were reported as surgically induced, 46 (33.8%) eyes had poor vault (<200 μm), and cataract surgery was carried out in 27.9% (n=38) of eyes. Early acute intraocular pressure increase was also reported to be relatively frequent, whereas acute pupillary block was less frequent and mostly resolved with additional iridotomies. A total of 42 ICLs were explanted due to cataract and IOP. Reported endothelial cell loss varied from 9.9% at 2 years to 3.7% 4 years postoperatively. This loss was reported to be more pronounced within the first 1 to 2 years, with stability or lower progression after that time.

CONCLUSIONS

The majority of reported complications after ICL implantation are cataract formation. The improvements in lens geometry and more accurate nomograms applied to the selection of the lens to be implanted, in addition to the surgeon's learning curve, might be factors in the decreased occurrence of postoperative complications reported currently.

Phakic intraocular lens implantation in United States military warfighters: a retrospective analysis of early clinical outcomes of the Visian ICL

PURPOSE

To assess short-term clinical outcomes after implantation of phakic intraocular lenses (Visian ICL, STAAR Surgical Co) in US military warfighters who are not good candidates for laser vision correction.

METHODS

A retrospective interventional consecutive case series analysis of all eyes that underwent ICL surgery during a 14-month time period was performed. Main outcome measures included indications for surgery, efficacy, predictability, and early adverse events.

RESULTS

Three-month postoperative visual data were available for 135 eyes of 69 patients who underwent ICL implantation during the study period. Indications included abnormal corneal topography (37%), thin predicted residual bed following LASIK (32%), history of dry eye (13%), thin corneal thickness (11%), or other (7%). Mean patient age was 30.9 ± 6.6 years. Mean preoperative spherical equivalent refraction was -6.00 ± 1.92 diopters (D) (range: -2.63 to -11.50 D). Three months postoperative, uncorrected distance visual acuity of 20/20 or better was found in 129/135 (96%) eyes and 91/135 (67%) were 20/15 or better. Manifest refraction and corrected distance visual acuity (CDVA) data were available for 128 eyes. Forty-two (33%) eyes had improvement of one or more lines of CDVA. One hundred fifteen eyes (90%) were within ± 0.50 D of emmetropia, and predictability within ± 0.75 D was found in 127/128 (99%) eyes. No significant intra- or postoperative complications were observed.

CONCLUSIONS

This retrospective analysis of 3-month outcomes suggests that Visian ICL implantation in myopic warfighters provides excellent refractive and visual results. Further study is needed to evaluate long-term results.

Vaulting of myopic and toric Implantable Collamer Lenses during accommodation measured with Visante optical coherence tomography

PURPOSE

To study changes in vaulting of myopic and toric Implantable Collamer Lenses (ICLs) version 4 during accommodation with Visante optical coherence tomography (OCT), and analyze the relationship between vaulting and anterior subcapsular opacification.

DESIGN

Cross-sectional study.

PARTICIPANTS

Seventy-seven eyes of 77 myopic patients were examined after implantation with an ICL (48 myopic, 29 toric). The median follow-up time was 63 months (range, 10-84).

METHODS

The distance between the posterior ICL surface and the anterior surface of the crystalline lens was measured in the nonaccommodative state and during accommodation with Visante OCT. The lenses were examined for opacification using slit-lamp microscopy.

MAIN OUTCOME MEASURES

The distance between the ICL and the anterior surface of the crystalline lens.

RESULTS

At baseline, the mean distance between the ICL and the crystalline lens was 0.31+/-0.19 mm and during accommodation 0.31+/-0.26 mm; the difference did not reach significance (P = 0.77). The distance at baseline was significantly (P = 0.01) less in older patients and significantly (P = 0.04) greater in patients with a toric ICL. Contact was observed at baseline or during accommodation in 12 eyes; there was a significantly lower incidence of contact in eyes implanted with a toric ICL (P = 0.03). Anterior subcapsular opacification developed in 10 eyes, in 5 of these the ICL touched the crystalline lens.

CONCLUSIONS

Anterior subcapsular opacification developed in 13.0% of eyes. We found no difference in vaulting of the ICL at baseline and during accommodation. There was contact between the ICL and the crystalline lens in 15.6% of the eyes. The association between anterior subcapsular opacification and contact was significant (P = 0.004).

Changes in iridocorneal angle structure and trabecular pigmentation with STAAR implantable collamer lens during 2 years

PURPOSE

To evaluate the changes in iridocorneal angle structure and trabecular pigmentation after implantation with the STAAR Implantable Collamer Lens (ICL), as potential risk factors of secondary glaucoma.

METHODS

An ICL was implanted in 48 eyes of 29 patients with high myopia. Angle opening distance (distance between trabecular meshwork and iris) measured at 500 microm from the scleral spur and trabecular-iris angle were assessed preoperatively and at 1, 6, 12, and 24 months postoperatively by ultrasound biomicroscopy, and trabecular pigmentation was evaluated preoperatively and at 1, 12, and 24 months postoperatively by standardized gonioscopic photography.

RESULTS

Mean follow-up was 33.2 +/- 7.3 months. One-month postoperative trabecular-iris angle and angle opening distance values were significantly smaller than preoperative values by 41.5% and 31.8%, respectively (P < .001), but no significant progressive changes were observed thereafter. The mean trabecular pigmentation of four quadrants did not change significantly during the first month after ICL implantation (P = .317), but significantly decreased at 1 and 2 years postoperatively compared with the preoperative value (P = .039 and .047, respectively). Intraocular pressure (IOP) remained stable in all eyes throughout follow-up except in one eye, which showed elevated IOP and significantly increased trabecular pigmentation requiring antiglaucoma medications.

CONCLUSIONS

No ongoing narrowing of iridocorneal angle was noted after approximately 40% narrowing at 1 month postoperatively. There was no general increase in trabecular pigmentation or IOP over a mean follow-up of 33.2 months. Considering significant initial angle crowding and one eye with increased trabecular pigmentation and IOP, careful monitoring of iridocorneal angle and IOP is required during the early postoperative period, especially for 1 month.

Factors affecting vaulting after implantable collamer lens implantation

PURPOSE

To evaluate the vaulting of the STAAR Implantable Collamer Lens (ICL) over the crystalline lens after implantation.

METHODS

One hundred twenty-three eyes of 68 patients with myopic refractive errors of -3.25 to -22.75 diopters undergoing ICL implantation were examined retrospectively. The magnitude of the central vaulting of the ICL was assessed quantitatively using slit-lamp microscopy at 3 months after surgery. Multiple regression analysis was used to assess the factors affecting the amount of vaulting.

RESULTS

The mean central vaulting 3 months after surgery was 603.6 +/- 259.6 microm. Explanatory variables relevant to the vaulting were, in order of influence, the horizontal white-to-white distance (partial regression coefficient B = 0.268, P = .0002) and patient age (B = -0.007, P = .011).

CONCLUSIONS

Although the majority of the variance remains unexplained, younger patients' eyes and eyes with greater white-to-white distances are more predisposed to have higher ICL vaulting over the crystalline lens.

Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism

PURPOSE

To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism.

SETTING

Department of Ophthalmology, Kitasato University, Kanagawa, Japan.

METHODS

This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] <or=-6.0 diopters [D]; manifest refractive cylinder >or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively.

RESULTS

At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations.

CONCLUSION

Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.

Time course of accommodation after implantable collamer lens implantation

PURPOSE

To assess the time course of accommodative function after Implantable Collamer Lens (ICL) implantation and to investigate the relationship between patient age and accommodation in ICL-implanted eyes.

DESIGN

Prospective, nonrandomized clinical trial.

METHODS

We prospectively examined 69 eyes of 40 consecutive patients with myopic refractive errors of -3.25 to -22.75 diopters (D) who were undergoing ICL implantation. We assessed the amplitude of accommodation using an accommodometer before and one, three, six, and 12 months after surgery. We also investigated its relationship with patient age.

RESULTS

The accommodation was 6.36 +/- 3.94 D (mean +/- standard deviation) before surgery and 4.89 +/- 2.72 D, 4.98 +/- 2.67 D, 5.16 +/- 2.72 D, and 5.72 +/- 2.85 D at one, three, six, and 12 months after surgery, respectively. The variance of data was statistically significant (P = .02, repeated-measures analysis of variance). Multiple comparisons demonstrated significant differences between measurements made before surgery and at one month after (P = .004, Fisher least significant difference test), before surgery and at three months after (P = .007), and before surgery and at six months after (P = .01). There was a significant correlation between patient age and accommodation before (Pearson correlation coefficient, r = -0.665; P < .001) and one year after (r = -0.803; P < .001) ICL implantation.

CONCLUSIONS

Accommodation was impaired transiently in the early postoperative periods, and then recovered gradually over time, indicating that transient dysfunction of the ciliary muscles by ICL fixation may occur after ICL implantation even if the crystalline lens remained intact. As patients aged, the amplitude of accommodation became significantly smaller not only in normal eyes but also in ICL-implanted eyes.

Optical Coherence Tomography of the Anterior Segment in Eyes with Phakic Refractive Lenses

PURPOSE

To evaluate the dynamics of the phakic refractive lens (PRL) in myopic and hyperopic eyes in the nonaccommodated state and during subjective accommodation with Visante optical coherence tomography (OCT).

DESIGN

Cross-sectional study.

PARTICIPANTS

Forty-one myopic eyes and 11 hyperopic eyes of 52 patients (mean age, 34 years; range, 24-49) were examined at least 1 year after PRL implantation using Visante OCT. Thirty-one myopic eyes had the PRL model 101 and 10 eyes had the smaller PRL model 100 implanted. The hyperopic model, PRL 200, is available in only one size.

METHODS

Noninvasive high-resolution anterior OCT was used to measure distance changes between the PRL and adjacent intraocular structures in the nonaccommodative state (baseline) and during accommodation.

MAIN OUTCOME MEASURES

Mean distance changes from the anterior lens surface (ALS) to the PRL and from the corneal posterior surface to the ALS and the PRL, and changes in the pupil diameter.

RESULTS

At baseline, the mean distances between the PRL and crystalline lens were 0.38, 0.30, and 0.32 mm for the PRL 101, PRL 100, and PRL 200, respectively. The PRLs were significantly closer to the crystalline lens with increasing patient age. Three PRLs were in contact with the crystalline lens (6%), and there were lens opacities in 2 of these eyes. During accommodation, the ALS of all PRL models showed significant forward movement (P<0.05), whereas the distance between the PRL and crystalline lens decreased significantly with the PRL 101 and PRL 200 (P<0.05). The distance between the PRL 100 and crystalline lens remained unchanged during accommodation.

CONCLUSION

The PRL moved forward during accommodation in all eyes, with the distance preserved between the PRL and the ALS with the PRL 100. The distance decreased with the other 2 models. In 85% of cases, there was no mechanical contact with the ALS during accommodation.

Outcome of simultaneous phakic implantable contact lens removal with cataract extraction and pseudophakic intraocular lens implantation

PURPOSE

To assess the outcome of simultaneous implantable contact lens (ICL) removal and cataract extraction with pseudophakic intraocular lens (IOL) implantation.

SETTING

CODET Aris Vision Institute, Tijuana, Mexico.

METHODS

This retrospective noncomparative interventional case series evaluated 14 eyes of 12 patients with ICL implantations who developed a cataract and simultaneously had ICL removal and cataract extraction with IOL implantation. The follow-up time was at least 6 months (range 6 to 24 months). Visual acuity (logMAR), manifest refraction, intraocular pressure, and adverse events were recorded.

RESULTS

Of the 12 patients (14 eyes), 10 patients (12 eyes) had ICL surgery to correct high myopia and 2 patients (2 eyes), to correct hyperopia. The mean uncorrected visual acuity after ICL implantation (before cataract development), before cataract surgery, and after cataract surgery were 0.48 +/- 0.32, 0.83 +/- 0.34, and 0.40 +/- 0.27, respectively. The mean best corrected visual acuity (BCVA) before ICL implantation, after ICL implantation, and after cataract surgery were 0.31 +/- 0.21, 0.28 +/- 0.19, and 0.27 +/- 0.21, respectively. The mean final manifest spherical equivalent was 0.30 diopters (D) +/- 1.07 (SD) (range +2.38 to 2.0 D). Ten eyes (71.4%) were within +/-1.0 D of the calculated target. One eye had a tear in the posterior capsule with vitreous loss during cataract surgery. No other intraoperative, perioperative, or postoperative complications were observed. No loss of BCVA was recorded at the last postoperative visit.

CONCLUSIONS

Lens opacities and cataract formation are a potential complication of ICL surgery. The removal of the ICL and the cataract with IOL implantation was found to be safe, with predictable refractive results.