A Rare Case of Pupillary Block Glaucoma Following CentraFLOW Implantable Collamer Lens Surgery

Severe intraocular pressure rise after implantable collamer lens implantation

A 22-year-old woman with a history of high myopia (-8.00 -3.75 × 011, right eye; -6.75 -3.75 × 174, left eye) presented to our clinic for implantable collamer lens (ICL) evaluation. Medical history was noncontributory. The patient's father had a history of glaucoma. Slitlamp and dilated fundus examination were unremarkable with a cup-to-disc ratio of 0.5 in both eyes and a myopic fundus. Intraocular pressures (IOPs) were 20 mm Hg in the right eye and 19 mm Hg in the left eye. Galilei G4 (Ziemer USA, Inc.) measured a white-to-white (WTW) distance of 12.98 mm in the right eye and 13.05 mm in the left eye and central corneal thickness of 512 μm in the right eye and 504 μm in the left eye. Ultrasound biomicroscopy (UBM) (Sonomed Escalon) displayed a sulcus-to-sulcus distance of 12.76 mm in the right eye and 12.75 mm in the left eye and an anterior chamber depth (ACD) of 3.57 mm in the right eye and 3.79 mm in the left eye (Figure 1JOURNAL/jcrs/04.03/02158034-202409000-00014/figure1/v/2024-08-19T175148Z/r/image-tiff). Prednisolone acetate 0.1% ophthalmic suspension eye drops and ofloxacin 0.3% ophthalmic solution eye drops 4 times daily were prescribed prophylactically 2 days preoperatively. A -12.5 and -12 D EVO+ Visian toric ICL -13.2 mm (STAAR Surgical Co.) was implanted along the 180-degree meridian in the right eye and left eye, respectively. Immediate postoperative IOPs were 23 mm Hg in both eyes. The patient was instructed to continue ofloxacin drops for 1 week and taper prednisolone acetate drops over 1 month. On postoperative day (POD) 1, uncorrected distance visual acuity (UDVA) was 20/20 in the right eye and 20/25 in the left eye. The patient's IOP was 24 mm Hg in the right eye and 26 mm Hg in the left eye. Anterior chambers (ACs) were unremarkable with minimal edema at the clear temporal corneal incision sites. Anterior segment optical coherence tomography (AS-OCT) vault measurements were 766 μm in the right eye and 697 μm in the left eye. Subsequently, the prednisolone dosage was reduced to 3 times a day, and brimonidine eye drops 3 times a day in both eyes were added to the regimen. On POD 5, the patient returned to the clinic reporting sudden-onset blurred vision with severe retro-orbital pain in the left eye upon awakening. Her UDVA was 20/25 in the right eye and 2/40 in the left eye. IOP was 30 mm Hg in both eyes. The ACs were deep, and there was minimal corneal edema in both eyes. Vaults were 674 μm in the right eye and 623 μm in the left eye (Figure 2JOURNAL/jcrs/04.03/02158034-202409000-00014/figure2/v/2024-08-19T175148Z/r/image-tiff). The patient was instructed to reduce prednisolone to 2 times a day, discontinue brimonidine, and start brimonidine/timolol (Combigan) 2 times a day and latanoprost at bedtime in both eyes. At the routine 1-week postoperative appointment, the patient's IOP was 30 mm Hg in the right eye and 29 mm Hg in the left eye. The patient was instructed to reduce prednisolone to once a day, continue brimonidine/timolol 2 times a day and latanoprost at bedtime, and start acetazolamide (Diamox) 250 mg 2 times a day. The patient was told to return to the office in a few days for an IOP check. What are the differential diagnoses concerning this case? What is the most likely mechanism underlying this patient's elevated IOP? What additional diagnostic workup would aid you in making the correct diagnosis?

Evaluation of biometric indicators of anterior segment parameters after ICL implantation by swept-source optical coherence tomography

BACKGROUND

To evaluate anterior segment structural alterations after implantable collamer lens (ICL) implantation in myopic patients using swept-source quantitative optical coherence tomography (SS-OCT).

METHODS

This prospective study included 47 eyes in 24 patients with preoperative spherical equivalent ≥ -3.00 D. Patients underwent ICL implantation at Department of Ophthalmology, Peking University Third Hospital, from May 2021 to December 2022. SS-OCT was used to measure anterior chamber width (ACW), angle opening distance (AOD), angle recess area (ARA), trabecular-iris area (TISA), trabecular-iris angle (TIA), iridotrabecular contact (ITC) area, and ITC Index before ICL implantation surgery and at 1 month follow-up. The correlations among the ITC index, vault, and angle parameters were analysed. Receiver operating characteristic (ROC) analysis was used to explore the ability of the vault to identify eyes with suspected angle-closure.

RESULTS

At one month following ICL implantation, the ITC area was 0.396 ± 0.37 mm², and the ITC index is 8.143 ± 5.439%. All angle parameters, except ACW, showed a statistically significant reduction on SS-OCT (P < 0.05). Mean AOD500, AOD750, ARA500, ARA750, TISA500, TISA750, TIA500, and TIA750 values at one month postoperatively decreased by 60.0%, 60.4%, 58.1%, 59.2%, 57.3%, 58.7%, 48.8%, and 50.7%, respectively. The vault was positively correlated with the ITC index and percent change in anterior chamber angle parameters. A vault of > 0.659 mm was found to be optimal for angle-closure suspect with a sensitivity of 85.2% and a specificity of 53.9%.

CONCLUSIONS

Anterior chamber angle parameters decreased one month after ICL implantation, and their percentage changes and ITC index correlated with the vault. When the vault is larger than 0.659 mm, it is necessary to be alert to possible closed angle suspicion.

EVO/EVO+ Visian Implantable Collamer Lenses for the correction of myopia and myopia with astigmatism

INTRODUCTION

Intraocular lens implantation in phakic eyes for the correction of refractive error is currently a widespread procedure. The EVO and EVO+ Visian Implantable Collamer Lenses (ICL) are two of the most prevalent lenses implanted. They incorporate a central orifice to avoid the need for iridotomy. The main difference between both ICL is the higher optical diameter zone provided by the EVO+, allowing a better quality of vision at night. This review aims to provide an overview of the current ICL models available for correcting myopia and myopic astigmatism.

AREAS COVERED

During the last decade, more than 100 scientific papers analyzing the performance of EVO and EVO+ lenses have been published. This review describes the objective visual performance achieved with the implantation of central hole ICL lenses and the subjective perception of the patients implanted with these lenses. In addition, the safety and the potential complications associated with undergoing an EVO and EVO+ ICL implantation have been addressed.

EXPERT OPINION

Refractive surgeons and candidates to undergo ICL implantation should be aware of the excellent safety and visual outcomes provided by the implantation of central hole ICL lenses. However, future research could address minor issues currently not resolved.

Intraocular Implantable Collamer Lens with a Central Hole Implantation: Safety, Efficacy, and Patient Outcomes

This review summarizes the available literature and provides updates on the efficacy, safety, and patient outcomes of phakic intraocular lens implantation using implantable collamer lens (ICL), with a focus on newer models with a central port (EVO/EVO+ Visian Implantable Collamer Lens, STAAR Surgical Inc.). All studies included in this review were identified from the PubMed database and were reviewed for relevancy of their topic. Data on hole-ICL implantation performed between October 2018 and October 2022 in 3399 eyes showed a weighted average efficacy index of 1.03 and a weighted average safety index of 1.19 within an average follow-up of 24.7 months. The incidence of complications such as elevated intraocular pressure, cataract, and corneal endothelial cell loss was low. Moreover, both quality of vision and quality of life improved after ICL implantation, confirming the benefits of this procedure. In conclusion, ICL implantation is a promising refractive surgery alternative to laser vision correction with excellent efficacy, safety, and patient outcomes.

Complications following implantation of posterior chamber phakic intraocular lens (pIOL)

A male patient in his 20s presented with right eye aphakic corneal decompensation and left eye intumescent cataract with phakic intraocular lens (pIOL) lenticular touch. He had a history of pIOL implantation in both eyes 6 months ago. On first postoperative day, uncorrected distance visual acuity was 20/400 and 20/20 in right and left eye, respectively. Postoperatively, a diagnosis of right eye toxic anterior segment syndrome (TASS) was made and pIOL was explanted. Subsequently, the patient developed intumescent cataract for which lens aspiration with posterior chamber intraocular lens (PCIOL) implantation was performed in the right eye. Ongoing uveitis with membrane formation warranted PCIOL explantation. The patient developed aphakic corneal decompensation in the right eye and underwent penetrating keratoplasty with intrascleral haptic fixation of an intraocular lens. Central pIOL-lenticular touch with intumescent cataract was diagnosed in the left eye for which pIOL explant with lens aspiration and PCIOL was done. TASS and post-pIOL cataract are rare but vision-threatening complications require judicious management for visual rehabilitation.

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.

One-year Observation of Safety of Implantable Collamer Lens V4c Implantation Without Using an Ophthalmic Viscosurgical Device

Purpose

To investigate the feasibility and safety of the implantable collamer lens V4c (ICL V4c) implantation without using an ophthalmic viscosurgical device (OVD-free technique).

Methods

This prospective consecutive case study enrolled 118 eyes of 60 patients (15 eyes were of male patients, 103 eyes were of female patients, age 26.19 ± 5.03 years, spherical equivalent −10.05 ± 2.73 D). Eyes were considered for OVD-free or OVD-using ICL V4c implantation based on the maintenance of the anterior segment during the surgery. The follow-up lasted for 12 months. The main measurements were visual acuity and changes in endothelial cell density (ECD) at 12 months.

Results

A total of 75 eyes were included in the OVD-free group and 43 in the OVD group. No infection or other complications were observed in any eye. In the OVD-free group, the safety and efficacy indices were 1.19 ± 0.15 and 1.05 ± 0.20, respectively. 74.5% of the eyes gained one or two lines of corrected distance visual acuity (CDVA), and 25.5% were stable. In the OVD group, the safety and efficacy indices were 1.17 ± 0.17 and 1.03 ± 0.15, respectively; 65.7% of the eyes gained one or two lines of CDVA, and 34.3% were stable. The mean change of ECD was 65.34 cell/ mm² compared to the baseline in the OVD-free group and 25.94 cell/ mm² compared to baseline in the OVD group (P = 0.038).

Conclusions

The ICL V4c implantation with an OVD-free technique is a safe and feasible method in eyes with good maintenance of the anterior segment.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault

PURPOSE

To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia.

SETTING

Clinica Baviera, Madrid, Spain.

DESIGN

Retrospective cross-sectional single-center study.

METHODS

Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 μm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation.

RESULTS

The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 μm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 μm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group.

CONCLUSIONS

Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Posterior-chamber phakic implantable collamer lenses with a central port: a review

We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow‐up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time‐points post‐surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements—which were evaluated in some of the studies—were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient’s anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications.

Safety of implantable Collamer lens implantation without ophthalmic viscosurgical device: A retrospective cohort study

To compare the safety of implantable Collamer lens (ICL) implantation with and without ophthalmic viscosurgical device (OVD).A total of 148 eyes underwent a conventional ICL implantation with OVD (OVD group), and 112 eyes underwent a modified ICL implantation without OVD (OVD-free group). The balanced salt solution was used to load ICL and maintain the anterior chamber in the OVD-free group. The surgical time, postoperative uncorrected distance visual acuity, intraocular pressure, endothelial cell density (ECD), and percentage of hexagonal cells were compared between the OVD and the OVD-free groups.No significant differences were detected in uncorrected distance visual acuity, intraocular pressure, ECD, and percentage of hexagonal cells at any time post-surgery between the 2 groups (P > .05). The mean ECD loss was 1.9% in the OVD-free group and 2.3% in the OVD group at 2 years post-surgery (P = .680). The surgical time was much shorter in the OVD-free group than that in the OVD group (P ≤ .001). None of the following occurred at any time during the 2-year follow-up period in both groups: cataract formation, macular degeneration, or any other vision-threatening complications.OVD-free ICL implantation presented satisfactory results for safety. Compared to OVD, the OVD-free technique had the advantages of decreased surgical time, increased efficiency, and reduced cost.