Evaluation of Disk Halo Size after Implantation of a Collamer Lens with a Central Hole (ICL V4c)

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.

A Case of a Low Vault after Posterior Chamber Acrylic Phakic Intraocular Lens Implantation

When implanting a posterior chamber phakic intraocular lens (pIOL), it is crucial to maintain a safe distance. The patient was a 29-year-old man with high-degree bilateral myopia. In February 2021, posterior chamber acrylic pIOLs (Eyecryl Phakic TORIC; Biotech Vision Care, Gujarat, India) were implanted in both his eyes. After the surgery, the right eye vault was 6 μm, and the left eye vault was 350 μm. Moreover, the internal anterior chamber depth values were 2,270 and 2,220 μm for the right and left eyes, respectively. In our case, we found a fairly high crystalline lens rise (CLR) in both eyes, but it was greater in the right eye. The CLR value was +455 in the right eye and +350 in the left eye. In our patient, anterior segment anatomical parameters were higher in the right eye than in the left eye, and a greater pIOL length was calculated for the right eye, but the vault was very low. In our opinion, this was associated with the high CLR in the right eye. If an even larger pIOL had been implanted, there would have been a greater narrowing of the anterior chamber angle. This case would be contraindicated if those parameters were considered in selecting the indications and determination of the pIOL length.

A Comprehensive Investigation of Contrast Sensitivity and Disk Halo in High Myopia Treated With SMILE and EVO Implantable Collamer Lens Implantation

Purpose

To investigate the clinical outcomes in small incision lenticule extraction (SMILE) and EVO implantable Collamer lens (ICL)–treated high myopia.

Methods

Thirty-three SMILE-treated and 32 EVO ICL-treated patients were included and followed up for 6 months. Subjective refraction, contrast sensitivity, and disk halo size were measured preoperatively and postoperatively. Patient-reported outcomes (PROs) were obtained at the final visit.

Results

Significant differences in efficacy and safety indices were observed between the SMILE and EVO ICL groups at 6 months postoperatively (P < 0.05). In the SMILE group, the mesopic contrast sensitivity at 2.2 cycles per degree (cpd) and photopic contrast sensitivity at 0.5, 3.4, and 7.1 cpd were significantly improved. In the EVO ICL group, the mesopic contrast sensitivity at 7.1 cpd and photopic contrast sensitivity at 0.5, 7.1, and 14.6 cpd were significantly improved. The halo radii after SMILE were significantly increased at 1 week, showed a decreasing trend at 1 month, returned to baseline at 3 months, and progressed stably at 6 months. However, it was unchanged in the EVO ICL group. Regarding subjective experience, haloes were the most common disturbance with mild and little bothersomeness after EVO ICL in contrast to starbursts after SMILE.

Conclusions

EVO ICL implantation yielded better visual outcomes, improved contrast sensitivity particularly at high spatial frequencies, had a stabler disk halo size, and increased incidence of haloes, with less influence than that of SMILE.

Translational Relevance

The disk halo and PRO findings will be of benefit for consultations and evaluations in visual performance and disturbances.

EVO+ Implantable Collamer Lens KS-aquaPORT Location, Stability, and Impact on Quality of Vision and Life

PURPOSE

To determine the longitudinal variation in the KS-aquaPORT central hole location of the phakic EVO+I Implantable Collamer Lens (ICL) (STAAR Surgical) and analyze its influence on visual performance, quality of vision (QoV), and quality of life (QoL).

METHODS

A prospective study was performed including 36 patients who had EVO+ ICL implantation. The KS-aquaPORT central hole location (Cartesian and polar coordinates) was determined with respect to the pupil center and visual axis. The effect of time (6-month follow-up) on central hole location was analyzed using linear mixed models. The effect of the KS-aquaPORT location on visual performance, QoV, and QoL parameters was assessed with multivariate regression models.

RESULTS

With respect to the visual axis, no significant changes in KS-aquaPORT location were found during follow-up. With respect to the pupil center, the X-coordinate and radius of KS-aquaPORT location showed modest, but significant (P ≤ .05) differences between 1-week and 3-month postoperative visits, and between 1-week and 6-month visits. X-coordinate variation was significant (P = .022) between 1-and 6-month visits. With respect to the visual axis, greater KS-aquaPORT decentration was associated with worse visual acuity (X-coordinate: P = .004; radius: P = .006), and inferior decentration with longer xenon-type glare photostress recovery time (P = .021). With respect to the pupil center, a lower radius was associated with better QoV scores (P ≤ .01) and temporal decentration produced higher ring-shaped dysphotopsia (P = .007).

CONCLUSIONS

EVO+ ICL KS-aquaPORT location appears to be clinically stable up to 6 months postoperatively. A central location of the EVO+ ICL KS-aquaPORT hole is preferred because it allows reduced perception of dysphotopic phenomena that can result in better QoV. [J Refract Surg. 2022;38(3):177-183.].

Nighttime Symptoms After Monocular SMILE: A Contralateral Eye Study

Introduction

To investigate nighttime symptoms in patients with myopic anisometropia after monocular small incision lenticule extraction (SMILE) surgery.

Methods

Thirty-six patients who had undergone monocular SMILE more than 6 months previously were recruited at the Eye & ENT Hospital of Fudan University. The average age at surgery was 25.4 ± 6.1 years. Preoperative spherical equivalent (SE) was −3.77 ± 1.56 D in SMILE-treated eyes and −0.08 ± 0.66 D in unoperated eyes. Main measurements included uncorrected and corrected distance visual acuity, manifest refraction, halo radius, contrast sensitivity, nighttime symptoms, and patient satisfaction.

Results

The mean follow-up time was 13.9 ± 3.4 months. The efficacy and safety indexes were 1.18 and 1.28, respectively. The halo radius was not significantly different between SMILE-treated and unoperated eyes under luminance conditions of 1, 5, and 100 cd/m² (P = 0.055). No significant differences were observed in contrast sensitivity at all spatial frequencies between eyes under both uncorrected and corrected conditions (all P > 0.05). None of the patients reported moderate or severe symptoms at night. Mild symptoms (glare, halo, starburst) were reported and binocularly equal in 13 patients, whereas four patients reported better night vision in SMILE-treated eyes than unoperated eyes, and one of them experienced mild night vision disturbance. The overall satisfaction score was 9.39 ± 0.80.

Conclusions

The disk halo size and contrast sensitivity in SMILE-treated eyes were similar to those in unoperated eyes, and nighttime symptoms almost completely resolved after SMILE.

Biometric and ICL-related risk factors associated to sub-optimal vaults in eyes implanted with implantable collamer lenses

Background

To identify biometric and implantable collamer lens (ICL)-related risk factors associated with sub-optimal postoperative vault in eyes implanted with phakic ICL.

Methods

This study reports a retrospective case series of the first operated eye in 360 patients implanted with myopic spherical or toric ICL. Preoperatively, white-to-white (WTW), central keratometry (Kc) and central corneal thickness (CCT) were measured using the Pentacam. Anterior-segment optical coherence tomography (AS-OCT, Visante) was applied preoperatively for measuring the horizontal anterior-chamber angle-to-angle distance (ATA), internal anterior chamber depth (ACD), crystalline lens rise (CLR), anterior-chamber angle (ACA) and postoperatively the vault. Eyes were divided into three vault groups: low (LVG: ≤ 250 μm), optimal (OVG: > 250 and < 1000 μm) and high (HVG: ≥ 1000 μm). Multinomial logistic regression (MLR) was used to find the sub-optimal vault predictors.

Results

MLR showed that CLR, ICL size minus the ATA (ICL size-ATA), age, ICL spherical equivalent (ICLSE) and ICL size as contributing factors for sub-optimal vaults (pseudo-R² = 0.40). Increased CLR (OR: 1.01, CI: 1.00–1.01) and less myopic ICLSE (OR: 1.22, CI: 1.07–1.40) were risk factors for low vaults. Larger ICL size-ATA (OR: 41.29, CI: 10.57–161.22) and the 13.7 mm ICL (OR: 7.08, CI: 3.16–15.89) were risk factors for high vaults, whereas less myopic ICLSE (OR: 0.85, CI: 0.76–0.95) and older age (OR: 0.92, CI: 0.88–0.98) were protective factors.

Conclusion

High CLR and low ICLSE were the major risk factors in eyes presenting low vaults. In the opposite direction, ICL size-ATA was the major contributor for high vaults. This relationship was more critical in higher myopic ICLSE, younger eyes and when 13.7 mm ICL were used. The findings show that factors influencing the vault have differentiated weight of influence depending on the type of vault (low, optimal or high).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40662-021-00250-6.

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.

Reasons for explantation of phakic intraocular lenses and associated perioperative complications: cross-sectional explant registry analysis

Background

We discuss the safety, since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications.

Methods

This retrospective, cross-sectional study included 69 pIOLs, explanted at a single tertiary center between July 2005 and March 2020: 34 angle-supported (G1), 28 iris-fixated (G2) and seven posterior chamber (G3) pIOLs. Case data including the reason for explantation was taken from the patient records. Intra- and postoperative complications were evaluated for an association with the pIOL.

Results

The mean duration in the eye was 10.4 (0.2–28) years. Cataractogenesis and subsequent surgery that required pIOL explantation was the reason in 42% of all cases. In 22%, cataract in combination with endothelial damage prompted explantation, with 26, 18 and 14% for G1, G2 and G3 respectively. The second most common reasons were corneal damage alone in the angle-supported group (26%), IOL subluxation in the iris-fixated group (18%), and photopic disturbance in the posterior chamber group (29%). In 68% of all explantations, the surgical course was unremarkable, while in the remaining cases perioperative complications were associated with the lens in 45.7%.

Conclusion

Overall, the need for cataract surgery was the most common reason for pIOL explantation. Corneal complications were more frequent in the angle-supported pIOLs and their removal was associated with higher rates of complication compared to the other groups.