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

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.

Clinical observations of EVO-ICL implantation and changes in corneal astigmatism using a modified technique

Background

Implantable collamer lens (ICL) surgery techniques are constantly progressing. The purpose of this study was to investigate the application effect of the modified technique and its impact on the change in corneal astigmatism in EVO-ICL surgery.

Methods

The analysis of retrospective cohort data included 153 eyes of 81 patients with myopia from July 2018 to May 2020. An EVO-ICL was inserted by modified surgical skills, including a single 3.0 mm corneal incision and no ophthalmic viscosurgical device (OVD) before the insertion of the ICL (modified technique group: 41 cases, 80 eyes) and standard procedure (standard technique group: 40 cases, 73 eyes). Early postoperative intraocular pressure (IOP) was monitored at 2 and 24 h. IOP, corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), vault, and anterior chamber depth (ACD) were measured 1, 6, and 12 months following the initial examination. The corneal endothelial cell density (ECD) was monitored at 6 and 12 months after the operation. Surgically induced astigmatism (SIA) in the total, anterior, and posterior corneal surfaces was analysed 1 month after the operation.

Results

No serious complications were detected. The two groups had no difference in visual outcomes, ICL vaults, or ACD at any time point (P > 0.05). Two hours postoperatively, IOP was significantly lower in the modified technique group (16.22 ± 2.22 vs. 18.37 ± 1.92 mmHg, P < 0.05) than in the standard technique group. IOP decreased gradually after 24 h to preoperative levels. The postoperative IOP remained stable over a 12-month period. The ECD at 6 and 12 months was not significantly different between the groups (P > 0.05). SIA in the total, anterior, and posterior corneal surfaces were assumed to have no clinically meaningful differences between groups at one month after operation (P > 0.05).

Conclusions

The modified technique is efficient and safe, producing comparable visual and structural outcomes without adversely affecting ECD, and reduces fluctuations in IOP at the early postoperative stages. The auxiliary incision in the standard technique does not increase corneal SIA, which is also a factor to consider for inexperienced surgeons.

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.

Safety of EVO ICL Implantation With an Ophthalmic Viscosurgical Device-Free Technique in the Early 24 h After Surgery

Purpose: To compare the safety of the non-ophthalmic viscosurgical device (OVD) technique with that of the minimum OVD technique in EVO Implantable Collamer Lens (EVO-ICL) implantation.

Methods: A total of 180 eyes of 90 consecutive patients were enrolled in the study, of which 100 eyes of 50 patients were treated with non-OVD technique, with a 55% success rate. The remaining 80 eyes of 40 patients were treated with min-OVD technique, so they were classified into the min-OVD group. Preoperative and postoperative intraocular pressure (IOP) measurements were collected and analyzed at 1, 2, 3, and 24 h. Visual acuity, corneal endothelial cell density (ECD), and corneal densitometry 24 h postoperatively were evaluated.

Results: No significant difference was found in visual outcomes (P = 0.54) or ECD (P = 0.78) between the two groups. The operation time was significantly shorter in the non-OVD group (P < 0.0001). The IOP was significantly higher at 1 h (P < 0.0001), 2 h (P < 0.0001) and 3 h (P = 0.0045) postoperatively in the min-OVD group. The non-OVD group had significantly lower IOP than the min-OVD group at 1 h (P = 0.01) and 2 h (P = 0.013) postoperatively. The temporal corneal densitometry in the non-OVD group were significantly lower than those in the minimum group (P = 0.0063) 1 day after surgery.

Conclusion: The non-OVD technique is safe and efficient for ICL implantation. It can be a safer method of ICL implantation in that it completely eliminates ophthalmic viscoelastic devices related complications without causing additional complications in short term.

A primer on ocular viscosurgical devices

PURPOSE

To provide pharmacists with an overview of ocular viscosurgical devices (OVDs) and a comprehensive resource describing characteristics of commercially available agents.

SUMMARY

OVDs are substances that are injected into the eye during ophthalmic procedures, such as cataract surgery, to reduce injury to the endothelium that may result from surgical manipulation. Currently available OVDs are composed of one or more of the following active ingredients: sodium hyaluronate, sodium chondroitin sulfate, and hydroxypropylmethylcellulose. Rheologic properties of OVDs, such as viscosity, elasticity, pseudoplasticity, and cohesion, affect the products' function and performance. Based on rheologic properties, OVDs can be generally classified as cohesive or dispersive. Given each products' unique characteristics, OVDs are not interchangeable. An understanding of OVD characteristics and role in practice allows for improved product selection, which varies based on patient characteristics and procedure. Availability of OVD information and literature is generally lacking since OVDs are regulated by the US Food and Drug Administration (FDA) as medical devices. This primer includes an overview of relevant ophthalmic surgical practices and the landscape of comparative efficacy and safety literature to assist in formulary decision-making. This review also provides a comprehensive guide to commercially available OVDs and a discussion on practical considerations for the pharmacist.

CONCLUSION

Pharmacists may be tasked with handling OVDs in institutional settings. Knowledge about OVD rheologic properties, product characteristics, role in practice, and available literature is necessary for managing formularies and ensuring optimal product selection.