Posterior-Chamber Phakic Intraocular Lens Implantation in Patients over 40 Years of Age

One-stage versus two-stage bilateral implantable collamer lens implantation: a comparison of efficacy and safety

Implantable collamer lens implantation (ICL) represents a safe and effective treatment for myopia and myopic astigmatism. To compare the outcomes of a bilateral one-stage same day approach to a two-stage approach, the databases of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Two-stage surgery was performed at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOP) and ICL vaulting. In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were included in this study. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was - 7.9 ± 2.6 diopters (D) in the one-stage and - 8.0 ± 1.7 D in the two-stage group (p = 0.63) and improved to 0.00 ± 0.40 and - 0.20 ± 0.40 D at end of follow-up, showing slightly better stability in the one-stage group (p = 0.004). There was no difference in the efficacy (1.1 vs. 1.2, p = 0.06) and the safety index (1.2 vs. 1.2, p = 0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p > 0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p = 0.65; 99 vs. 99%, p > 0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p = 0.00007). There were no serious intraoperative complications in either group. In conclusion, this study demonstrates that both the one- and two-stage approaches are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential benefit.

Clinical and Aberrometric Outcomes of a New Implantable Collamer Lens for Myopia and Presbyopia Correction in Phakic Patients

PURPOSE

To assess the clinical and aberrometric outcomes of a new Implantable Collamer Lens (EVO Viva ICL; STAAR Surgical) to correct moderate to high myopia and presbyopia.

METHODS

The study included 80 eyes of 40 patients who had bilateral EVO Viva ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, presbyopic add power, binocular through-focus visual acuity, total ocular spherical aberration (SA), coma aberration, and root mean square of ocular higher order aberrations (RMS HOAs) (i-Trace Aberrometer; Tracey Technologies) for a 4.5-mm pupil size were evaluated.

RESULTS

The mean binocular postoperative UDVA and CDVA were 0.09 ± 0.19 and 0.02 ± 0.03 logMAR, respectively. The postoperative spherical equivalent was -0.61 ± 0.54 diopters (D). The presbyopic add power reduced from +1.31 ± 0.74 D preoperatively to +0.44 ± 0.58 D after surgery (P < .0001). The mean visual acuity was 0.1 logMAR or better (20/25 or better) across the vergence range from +0.50 to -1.50 D, better than 0.2 logMAR (20/32 or better) up to the vergence of -2.00 D, and remained better than 0.3 logMAR (20/40 or better) up to the vergence of -2.50 D. The total ocular aberrations induced by EVO Viva ICL were -0.34 ± 0.09 µm of SA, 0.24 ± 0.18 µm of coma, and 0.26 ± 0.12 µm of RMS HOAs.

CONCLUSIONS

The outcomes support that the new ICL might be a good alternative for myopia and presbyopia correction in patients aged between 45 and 55 years. Further studies are needed to evaluate the threshold lens misalignment from which the patient´s visual quality would be affected. [J Refract Surg. 2023;39(9):589-596.].

Binocular imbalance in patients after implantable collamer lens V4c implantation or femtosecond laser-assisted in situ keratomileusis for myopia with presbyopia

Aim

To investigate the long-term safety, efficacy, and binocular balance of monovision surgery using Implantable Collamer Lens (ICL) V4c implantation and Femtosecond Laser-Assisted in situ Keratomileusis (FS-LASIK) for the treatment of myopic patients with presbyopia.

Methods

This case series study involved 90 eyes of 45 patients (male/female = 19/26; average age:46.27 ± 5.54 years; average follow-up time:48.73 ± 14.65 months) who underwent the aforementioned surgery to treat myopic presbyopes. Data on manifest refraction, corrected distance visual acuity, dominant eye, presbyopic addition, intraocular pressure, and anterior segment biometric parameters were collected. The visual outcomes and binocular balance at 0.4 m, 0.8 m, and 5 m were documented.

Results

The safety index for the ICL V4c and FS-LASIK groups were 1.24 ± 0.27 and 1.04 ± 0.20 (p = 0.125), respectively. Binocular visual acuity (logmar) for 0.4 m, 0.8 m, and 5 m were -0.03 ± 0.05, -0.03 ± 0.02, and 0.10 ± 0.03 for the ICL V4c group, and -0.02 ± 0.09, -0.01 ± 0.02, and 0.06 ± 0.04 for the FS-LASIK group, respectively. The proportions of all patients with imbalanced vision at 0.4 m, 0.8 m, and 5 m distances were 68.89, 71.11, and 82.22%, respectively (all p > 0.05 between the two groups). There were significant differences in refraction between the balanced and imbalanced vision for patients at 0.4 m distance (for non-dominant eye spherical equivalent [SE]: -1.14 ± 0.17D and -1.47 ± 0.13D, p < 0.001), 0.8 m distance (for preoperative ADD:0.90 ± 0.17D and 1.05 ± 0.11D, p = 0.041), and 5 m distance (for non-dominant SE: -1.13 ± 0.33D and -1.42 ± 0.11D, p < 0.001).

Conclusion

ICL V4c implantation and FS-LASIK monovision treatment demonstrated good long-term safety and binocular visual acuity at various distances. After the procedure, the imbalanced patients' vision is primarily related to the age-related presbyopia and anisometropia progression caused by the monovision design.

Association between the site of clear corneal Phakic intraocular lens implantation incisions and the inflow of ocular surface fluid into the anterior chamber

Background

Posterior chamber phakic intraocular implantable collamer lens (ICL) implantation is an effective surgical option for the management of myopia. Over the past few years, the number of ICL surgeries has significantly increased. Postoperative inflammation and endophthalmitis are among the most serious complications after successful ICL surgery. Sometimes, when the blepharospasm is removed at the end of surgery, a small amount of the ocular surface fluid will flow into the anterior chamber, which can lead to an increased risk of infection and inflammation. However, little attention has been paid to this phenomenon.

Purpose

We conducted a retrospective study to compare the incidence of extraocular fluid inflow into the eye through the clear corneal incision (CCI) at two different positions (superior and temporal sides).

Methods

A total of 116 patients with myopia underwent superior CCI ICL implantation (n = 58) or temporal CCI ICL implantation (n = 58) at our hospital from October to December 2021. The incidence of conjunctival sac fluid entering the anterior chamber after eyelid fixative was removed was compared in both groups.

Results

Both groups were well matched in all parameters. Ocular surface fluid inflow into the anterior chamber was significantly higher in the superior CCI group (25/58, 47.1%) than in the temporal CCI group (1/58, 1.7%) (p < 0.05).

Conclusion

In the patients with ICL implantation, the temporal CCI was better than the superior CCI in avoiding the ocular surface fluid inflow into the anterior chamber, and the potential risk of infection and inflammation was lower.

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.

Determinants of Subjective Quality of Vision After Phakic Intraocular Lens Implantation

PURPOSE

To evaluate postoperative subjective quality of vision in patients who underwent Implantable Collamer Lens (ICL) (STAAR Surgical) implantation for correction of myopia and to identify potential predictive parameters.

METHODS

In this single-center cross-sectional study, a total of 162 eyes of 81 patients (58 women, 23 men) who underwent ICL implantation were analyzed. The Quality of Vision (QOV) questionnaire was used to assess patient-reported outcomes. Baseline characteristics (eg, age), treatment parameters (eg, surgical corrected refraction), and refractive (eg, residual refraction) and visual (eg, uncorrected distance visual acuity) outcomes were analyzed regarding their effect on QOV.

RESULTS

Mean age was 33.3 ± 7.0 years (range: 21 to 51 years) and mean preoperative spherical equivalent was -8.42 ± 2.49 diopters (D) (range: -3.25 to -14.38 D). After a mean postoperative follow-up period of 19 ± 14 months (range: 6 to 54 months), the safety index score was 1.23 ± 0.21 and the efficacy index score was 1.17 ± 0.22. The mean QOV scores were 35.5 ± 11.3, 32.2 ± 11.1, and 23.3 ± 16.1 for frequency, severity, and bothersomeness, respectively. The most frequently experienced symptoms were halos (90.1%) and glare (66.7%). Halos appeared in 66.7% of the patients "occasionally" and 5 of them (6.2%) experienced them "very often." Only 1 patient (1.2%) classified halos as "very bothersome." Patients older than 36 years reported visual symptoms more frequently (P < .05) and showed higher bothersomeness scores (P = .01).

CONCLUSIONS

Halos are the most commonly perceived long-term visual disturbance after myopic ICL implantation with a central hole. Visual symptoms can persist more than 6 months postoperatively, causing only minor disturbances in most cases. Older patients seem more prone to experiencing these symptoms. [J Refract Surg. 2022;38(5):280-287.].

Multicenter clinical outcomes of hole implantable collamer lens implantation in middle-aged patients

To assess the multicenter clinical outcomes of the implantation of hole implantable collamer lens (Hole ICL, ICL KS-AquaPORTTM; STAAR Surgical, Nidau, Switzerland) in patients of 45 years or more. We retrospectively assessed the surgery’s safety, efficacy, predictability, stability, and adverse events before surgery and after the surgery at 1 week; 1, 3, and 6 months; and 1 year, followed by once every year for approximately 2.2 years. A total of 118 eyes of 65 patients aged 45–65 years with myopic refractive errors ranging from − 2.13 to − 18.75 diopters (D) underwent hole ICL implantation and routine postoperative examinations. The average observation period was 2.2 ± 1.0 years. The safety and efficacy indices were 1.08 ±  0.21 and 0.87 ± 0.25, respectively. Manifest refraction changes of − 0.20 ± 0.43 D occurred from 1 month to the final visit after ICL implantation. Eight eyes (6.8%) developed asymptomatic anterior subcapsular cataract (ASC) immediately after surgery, and three eyes (2.5%) developed clinically significant symptomatic nuclear cataracts during the follow-up period. According to our experience, hole ICL implantation offered favorable outcomes in all measures of safety, efficacy, predictability, and stability, even in middle-aged patients, during the 2.2-year observation period.

Long-term follow-up for monovision surgery by Implantable Collamer Lens V4c implantation for myopia correction in early presbyopia

Purpose

To investigate the long-term safety and efficacy of monovision surgery using implantable collamer lens V4c (ICL V4c) implantation in myopic patients with early presbyopia.

Setting

Eye and ENT Hospital of Fudan University, Shanghai, China.

Design

Prospective case series study.

Methods

This study included 64 eyes of 32 patients with early presbyopia, who underwent bilateral ICL V4c implantation for myopia correction. Parameters, including mean spherical equivalent (SE), uncorrected distance visual acuity, corrected distance visual acuity, intraocular pressure, endothelial cell density, presbyopic add power, visual acuity (logMAR) of dominant eyes (D-eye), nondominant (nD-eye) eyes, and both eyes (Bi) at 0.4 m, 0.8 m, and 5 m were recorded at the last follow-up.

Results

All surgeries were uneventful. At the last follow-up, the safety indices were 1.23 ± 0.18 (D-eyes) and 1.21 ± 0.18 (nD-eyes) (p > 0.05); the efficacy indices were 0.95 ± 0.27 (D-eyes) and 0.92 ± 0.28 (nD-eyes) (p < 0.05), the SE was -0.62 ± 0.47 D (D-eyes); and − 1.21 ± 0.78D (nD-eyes) (p < 0.05), presbyopic add power was 1.31 ± 0.58 D. The visual acuity (logMAR) of D-eyes, nD-eyes, and binocular (Bi) at 5.0 m were: 0.06 ± 0.15 (D-eye), 0.21 ± 0.18 (nD-eye), (p < 0.01), and 0.04 ± 0.13 (Bi); 0.8 m: 0.03 ± 0.18 (D-eye), 0.08 ± 0.16 (nD-eye), (p > 0.05), and − 0.02 ± 0.11 (Bi); 0.4 m: 0.08 ± 0.09 (D-eye), − 0.02 ± 0.08 (nD-eye), (p < 0.001), and − 0.03 ± 0.09 (Bi). Subjects were very satisfied or felt excellent with their visual acuity at near (81.25%) and far distances (87.50%), respectively (versus preoperative, p < 0.001).

Conclusion

Monovision surgery using ICL V4c implantation is safe and practicable for correction of myopes with presbyopia, with long-term efficacy at near and far distances and patient satisfaction.