The Implantable Collamer Lens with a central port: review of the literature

Vertical implantable collamer lens as a novel method to increase rotational stability

PURPOSE

We investigated the vertical implantation of a toric implantable collamer lens (ICL) and compared the rotational stability with that of horizontal implantation.

METHODS

This matched comparative study retrospectively reviewed and analyzed data from patients who underwent ICL implantation from 2003-2022 by 1:1 matching vertical and horizontal (V and H toric groups, respectively) implantation patients according to preoperative astigmatism, spherical equivalent, sulcus-to-sulcus, anterior chamber depth, and ICL size. Visual acuity, manifest refraction, vaulting, and rotation were measured 3 months postoperatively.

RESULTS

We included 646 eyes (323 each in the V and H toric groups). No statistically significant difference was observed between groups in postoperative visual acuity, refractive error, and astigmatism. Vaulting was lower in the V toric group. (P < 0.001). The mean lens rotation in the V toric group was less than that in the H toric group (1.11 ± 2.84° versus 3.02 ± 10.34°, P = 0.001). The proportion of eyes in the V and H toric groups showing ≥10° of rotation was 2.5% (8 eyes) and 6.5% (21 eyes), respectively (P = 0.014). Despite repositioning from rotation, three (0.9%) and eight (2.5%) eyes required removal owing to lens re-rotation in the V and H toric groups, respectively.

CONCLUSION

Toric ICL vertical implantation showed good rotational stability, and appropriate visual acuity correction results with relatively low vaulting. This procedure therefore presents an effective novel method that could replace horizontal toric ICL implantation.

Clinical observations of EVO-ICL implantation with single incision without viscoelastic agent

BACKGROUND

To investigate the safety and effectiveness of non-viscoelastic agent technique for EVO-ICL implantation.

METHODS

A total of 181 myopia eyes that underwent non-toric ICL without viscoelastic agent through single incision from Beijing Tongren Hosipital were included. An analysis was conducted on the quantity of haptics that were initially implanted intraoperatively into the posterior chamber. Intraocular pressure (IOP) was evaluated at before and 2 h,24 h,1week,6month after surgery. Anterior chamber volume(ACV), anterior chamber depth(ACD), anterior chamber angle(ACA), pupil diameter(PD) and corneal densitometry density (ECD) were evaluated at before and 24 h postoperatively. Refractive outcomes were investigated at before, 24 h ,7 days and 6months. Vault was evaluated at 24 h ,7 days and 6months.

RESULTS

The efficacy and safety indices were 1.30 ± 0.32 and 1.31 ± 0.32, respectively. Of 181 eyes, 99 eyes received 4 haptics on the first attempt without any adjustment, and 72 eyes received lens alignment without an viscoelastic agent. The success rate of the viscoelastic agent free procedure was 94.5%. Two hours postoperatively, IOP was 17.41 ± 3.77 mmHg, which was significantly higher than baseline value (t = 8.930, P < 0.000), however there was no significant difference between preoperative IOP and IOP at 1 day ,1 week and 6 months postoperatively. The ECD changed from 2895.52 ± 253.73 cells/mm2 preoperatively to 2873.66 ± 244.17 cells/mm2 at 1 day and 2882.63 ± 239.97 postoperatively, and the difference was not statistically significant (t = 1.811, P = 0.072). The ACA was narrowed by 42% on the first day.

CONCLUSION

The pure viscoelastic agent free technique is an efficient and safe way for ICL implantation. It can be a safer method of ICL implantation because of it reduces the risk of complications associated with ocular hypertension at the early postoperative stages.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2000036335) at August 20, 2020.

Analysis after posterior chamber phakic intraocular lens implantation: 17- to 19-year follow-up study

PURPOSE

To evaluate the clinical outcomes of the Visian implantable collamer lens (ICL) in eyes with ≥17 years of follow-up.

SETTING

Single-center.

DESIGN

Retrospective observational study.

METHODS

70 eyes from 38 patients who underwent surgery between 2002 and 2006 with V4 ICL implantation were analyzed. Preintervention data included corrected distance visual acuity (CDVA), refraction, and intraocular pressure (IOP). At the 19-year mark, CDVA, refraction, IOP, endothelial count, and vault were measured using Tomey Casia 2 anterior pole tomography, along with recording long-term events.

RESULTS

The operated patients had a spherical correction between -4 diopters (D) and -21 D and a cylinder up to 7.5 D. The mean CDVA (decimal) at the 17-year check-up was 0.89 ± 0.18, with a spherical equivalent of -1.05 ± 1.36 D. IOP has remained stable because mean measurements before surgery and currently were 15.16 ± 2.54 mm Hg and 16.19 ± 3.29 mm Hg, respectively. The endothelial cell count showed values of 2191 ± 386 cells/mm2, with a maximum of 2804 cells and a minimum of 1125 cells. Finally, the vault obtained was 348.53 ± 234.58 mm. Over the years, 2 eyes developed angle-closure glaucoma and 9 eyes were operated on for the development of anterior subcapsular cataracts.

CONCLUSIONS

Visian ICL implantation demonstrated long-term visual and refractive stability, indicating it as a low-risk procedure. The ICL V4 model yielded satisfactory results for myopia and astigmatism correction after 17 years.

Visual Outcomes of Cataract Surgery in Patients with Previous History of Implantable Collamer Lens

Background/Objectives: This retrospective case series analyzed visual outcomes in patients with a prior history of implantable collamer lens (ICL) implantation who underwent cataract extraction (CE). A secondary aim was to investigate the relationship between vault height and the rate of cataract development. Methods: Visual acuity and refraction measurements were collected after CE at one week, one month and six months. Vault height measurements were correlated to the time until symptomatic cataracts were removed. Results: A total of 44 eyes were analyzed at six months after CE with efficacy and safety indexes of 1.20 ± 1.11 and 1.50 ± 1.06, respectively. In addition, 70% of eyes had a post-operative uncorrected distance visual acuity (UDVA) within one line of pre-operative corrected distance visual acuity (CDVA). Refractive predictability at six months demonstrated that 43% and 69% of eyes were within ±0.25 D and ±0.50 D of SEQ target, respectively. Astigmatism measured by refractive cylinder was ≤0.25 D in 17% and ≤0.50 D in 34% of eyes pre-operatively compared to 40% and 60% of eyes, respectively, at six months post-operatively. Vault heights one week after ICL (p < 0.0081) and one week before CE (p < 0.0154) demonstrated a positive linear regression with the time until CE. Conclusions: This sample population achieved favorable visual outcomes six months after CE, similar to six months after ICL implantation. Patients with a history of ICL implantation will similarly have a good visual prognosis after CE.

Clinical prediction of insufficient vaults after implantable collamer lens implantation

AIM

To determine the factors related to preoperative ocular characters that are predictive of insufficient vault (<250 µm) after implantable collamer lens (ICL V4c; STAAR Surgical) implantation.

METHODS

The participants underwent ICL surgery and were divided into the low (<250 µm) and normal (250-1000 µm) vault groups based on the postoperative vault at 3mo. The preoperative biometric parameters and clinical outcomes were compared between the two groups. The relationship between the 3-month vault values and preoperative ocular parameters were evaluated by Generalized estimating equations.

RESULTS

Sixteen (23 eyes) and 36 patients (63 eyes) were in the low and normal vault groups, respectively. All implantation procedures were uneventful with no cataract formation in the early postoperative period. The sulcus-to-sulcus lens rise (STSL) and iris ciliary angle (ICA) were correlated with vault at 3mo after surgery. Every 0.1 mm increase in STSL was associated with 38.9 µm decrease in the postoperative 3-month vault. A rise of 1 degree in ICA is associated with a reduction of 4 µm in vault.

CONCLUSION

Eyes with a narrow ciliary sulcus are associated with a higher rate of low vault after ICL implantation, suggesting a need for adjustments to the ICL size in these patients. Evaluating the characteristics of the ciliary sulcus contributes valuable information to predict low vault after surgery.

The comparison of white-to-white via triple person-times caliper measuring and machine-measuring in V4c implantable collamer lens implantation

This study aimed to compare the differences and characteristics of white-to-white (WTW) values obtained before V4c implantation using triple person-times caliper, IOL-Master 700, Pentacam HR, and UBM, and to assess their correlation with vaulting. A total of 930 myopia patients (1842 eyes) who were interested in undergoing ICL surgery were assessed before the procedure using various instruments. The WTW measurements were obtained using a triple person-times caliper, Pentacam HR, and IOL-Master 700, whereas the angle-to-angle (ATA) measurements were obtained using UBM. The size of the ICL was subsequently calculated using triple person-times caliper measurements. The vault of the ICL was assessed using Pentacam HR three months after the surgery. The WTW was determined to be 11.30 ± 0.29 mm, 11.43 ± 0.29 mm, and11.86 ± 0.38 mm, respectively, using the triple person-times caliper, Pentacam HR, and IOL-Master 700. The measurement of ATA was 11.57 ± 0.51 mm, as done by UBM. The ICL vault was measured to be 400.97 ± 198.46 µm when examined with Pentacam HR three monthsafter the procedure. The linear regression analyses of ICL size and WTW of triple person-times caliper, ICL vault and WTW were (R = 0.703, p < 0.001; R = 0.0969, p < 0.001) respectively. The highest correlation was found between IOL-Master and Pentacam HR (r = 0.766, p = 0.000). The lowest correlation was found between UBM and Pentacam HR (r = 0.358, p = 0.002). Bland-Altman analysis showed that the 95% limits of agreement (LoA) were the triple person-times caliper and Pentacam HR (- 0.573, 0.298) and the triple person-times caliper and UBM (- 1.15, - 0.605). This indicated a strong agreement between the triple person-times caliper and Pentacam HR and a lack of agreement between the triple person-times caliper and UBM. Triple person-times caliper measurements offer excellent maneuverability, practicality, and reliable outcomes for determining ICL vaults. Measurements obtained using the triple-person caliper were less differece than those obtained using the Pentacam HR.

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

OBJECTIVE

To present six cases exhibiting transient anterior subcapsular vacuolar lens opacities following early postoperative Tanito microhook trabeculotomy (TMH) performed by the same surgeon.

METHODS

Six patients who underwent lens-sparing TMH at Meizankai Shimizu Eye Clinic from November 2021 to May 2023, and developed anterior subcapsular vacuolar lens opacities postoperatively were reviewed. Detailed records of surgeries, follow-up findings were collected and reported.

RESULTS

In all six cases, anterior vacuolar subcapsular lens opacities were observed on the day after surgery, gradually decreasing without affecting visual acuity or contrast sensitivity. In all cases, without any specific interventions, the opacities disappeared by 21 months postoperatively.

CONCLUSION

Anterior subcapsular cataracts, characterized by a vacuolar appearance and transient existence, should be recognized as an early complication of ab interno glaucoma surgery, possibly linked to use of distributed ophthalmic viscosurgical devices and excessive anterior chamber irrigation leading to traumatic cataracts on the lens surface.

Ten-year follow-up of posterior chamber phakic intraocular lens with central port design in patients with low and normal vault

PURPOSE

To assess the clinical outcomes and postoperative complications of the implantable collamer lens (ICL) with a central port throughout 10 years of follow-up in patients with low and normal vault.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

DESIGN

Retrospective and comparative case series.

METHODS

This study included eyes that underwent a V4c ICL implantation with 10 years of follow-up. The eyes were divided into 2 groups according to the vault at 1 year postoperatively: vault <250 μm and between 250 μm and 800 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), vault, complications, and secondary surgeries were analyzed.

RESULTS

37 and 90 eyes were enrolled in the low and normal-vault groups, respectively. No differences in UDVA, CDVA, and refraction were found between the groups over 10 years of follow-up. No cases developed ICL-induced anterior subcapsular opacity over the follow-up period. 2 (5.4%) and 8 (8.9%) eyes in the low and normal-vault groups, respectively, required ICL exchange. 1 (2.8%) and 2 (2.2%) eyes in the low and normal-vault groups, respectively, required excimer laser to correct residual refractive error. The IOP remained stable throughout the 10-year follow-up. The loss in ECD from that preoperatively to 10 years postoperatively was 3.8% and 4.5% in the low and normal-vault groups, respectively ( P = .4). No pigment dispersion glaucoma or other vision-threatening complications were reported.

CONCLUSIONS

This study shows good long-term outcomes of the V4c ICL, supporting that the central hole provides safety to the procedure and prevents the potential risk associated with low vault.

Causes and outcomes of implantable collamer lens explantation in patients with corneal endothelial cell loss

PURPOSE

To investigate the correlated factors of corneal endothelial cell density (ECD) loss and ECD change in implantable collamer lens (ICL) explantation patients.

SETTING

Seoul St. Mary's Hospital, Seoul, South Korea.

DESIGN

Retrospective analysis.

METHODS

The study cohort consisted of 93 eyes from 50 patients who underwent ICL explantation. Correlation analysis was performed to assess the ocular parameters associated with ECD loss, while percentage of ECD change (ΔECD%) was monitored up to 6 months postoperatively. Receiver operating characteristic (ROC) curve was used to set cutoff values of ocular parameters to prevent ECD loss after explantation.

RESULTS

In multiple regression analysis, high vaulting, high vaulting/anterior chamber depth (ACD), low anterior chamber angle (ACA), and high iris pigmentations are the significant factors of ECD loss. At postoperative 6 months, 14 eyes (15.1%) had decrease (10.5% loss), 47 eyes (51.0%) were stationary, and 32 eyes (34.4%) had increase (12.7% gain) of ECD. The ROC curve analysis showed that vaulting had the highest area under the curve (AUC = 0.822), followed by vaulting/ACD (AUC = 0.821), ECD (AUC = 0.753), and ACA (AUC = 0.723) (all P < .01). Preoperative ECD showed a sensitivity of 77.6% and specificity of 86.7% in preventing ECD loss after explantation, with a cutoff value of 1722 cells/mm 2 , as determined by ROC curve analysis.

CONCLUSIONS

Our study demonstrated that high vaulting is a significant factor in ECD loss among ICL-inserted patients. To prevent continuous ECD loss in ICL patients, close monitoring of ECD and making appropriate decisions regarding explantation may be necessary.

Bibliometric and visualized analysis of posterior chamber phakic intraocular lens research between 2003 and 2023

Introduction

Myopia is causing a major public health concern, with its prevalence increasing globally. This study aimed to discuss posterior chamber phakic intraocular lens (pIOL) research publication trends and hotspots over the past 20 years.

Methods

Bibliometric analysis was performed using the Web Science Core Collection to investigate posterior-chamber pIOL research publication trends. The extracted records were analyzed, and a knowledge map was built using VOSviewer v.1.6.20. The analysis included visualizing the annual publication count, countries/regions distribution, international and institutional collaborations, author productivity, and journal contribution, in addition to identifying knowledge bases and hotspots. Burst keywords were extracted using CiteSpace v.6.1.R.

Results

In total, 791 articles on posterior chamber pIOLs published between 2003 and 2023 were retrieved. China had the highest number of publications, whereas Japanese papers received the most citations. Fudan University had the highest number of publications, with articles from Kitasato University having the highest number of citations. Regarding individual research, Xingtao Zhou has published the most significant number of articles, and Shimizu Kimiya had the highest number of citations. The top productive/influential journal was 'Journal of Cataract & Refractive Surgery'. The top cited references primarily focused on reporting the clinical outcomes of implantable collamer lens (ICL) for individuals with moderate to high myopia. The keywords primarily formed four clusters: posterior chamber pIOL clinical outcomes for myopic astigmatism correction, posterior chamber pIOL implantation complications, ICL size selection and postoperative vault predictions, and postoperative visual quality following posterior chamber pIOL implantation.

Conclusion

This study presents the first bibliometric analysis of research trends in posterior chamber pIOL over the past two decades. We investigated the current state and emerging trends of global collaboration and research focal points in this field, offering fresh insights and guidance for researchers.

Implantable Collamer Lens Procedure Planning: A Review of Global Approaches

More than 2 million implantable collamer lenses (ICLs) have been implanted worldwide. With a central port to improve aqueous flow through the ICL, the latest iteration of this phakic intraocular lens (pIOL) has been shown to have stable outcomes with very low rates of adverse events. However, correct planning and ICL size selection continue to be important to achieve an optimal vault. Shallow or excessive vaults are not complications in and of themselves but may increase the risk of complications. Historically, surgeons have relied on measurements of anterior chamber depth (ACD) and manual, caliper-measured white-to-white (WTW) distance to select the ICL size. New diagnostic and imaging technologies such as optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) provide additional opportunities for visualization and measurement of the intraocular dimensions involved in phakic intraocular lens implantation, including sulcus-to-sulcus (STS) and angle-to-angle (ATA) diameters. This paper reviews various approaches to ICL planning and sizing that have been published in the peer-reviewed literature, all of which produce acceptable results for predicting vault and size selection. Surgeons may also want to identify a methodology for patient evaluation and ICL size selection that best aligns with their personal preferences, diagnostic technology, and familiarity with analytical optimization tools.

Endothelial cell loss post-implantable collamer lens V4c: meta-analysis

Endothelial cell density (ECD) loss is a noted effect of implantable collamer lens (ICL) V4c surgery. Current literature provides a wide range of values for ECD loss postsurgery, which may not be helpful in advising patients and clinicians. A meta-analysis exploring ECD loss in ICL V4c for myopia correction was undertaken. 18 studies were included in this meta-analysis with 2 subgroup analyses to account for the variability in follow-up lengths. The average ECD loss 3 months, 12 months, and 21.25 (mean) months postsurgery were 1.32% ± 1.28% ( P < .001, 95% CI, -75.158 to -1.19), 1.75% ± 2.17% ( P < .001, 95% CI, -134.09 to 14.52), and 3.84% ± 1.78% ( P < .001, 95% CI, -156.04 to -54.26), respectively. ECD loss is most pronounced 3 months postsurgery, suggesting that acute surgical trauma was the primary contributor rather than long-term lens implantation. Overall, ICL V4c is for myopia correction exhibits similar ECD loss as seen in other ICL models, thereby affirming its safety.

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.

A review of posterior chamber phakic intraocular lenses

PURPOSE OF REVIEW

Posterior chamber phakic intraocular lenses (pIOLs) are increasing in popularity as a viable alternative to laser refractive surgery. The purpose of this review is to evaluate the recent updates to pIOLs and to assess the advancements and safety of the procedure.

RECENT FINDINGS

Accurate lens sizing is the key determinant to suitable vault prediction, advancements to sizing formulae including the use of very high frequency (VHF) digital ultrasound and the application of artificial intelligence and machine learning has led to improved vault prediction and safety. The introduction of the central aquaport has been shown to reduce the formation of cataract and is now adopted in most myopic pIOLs. Recently published studies have demonstrated that pIOLs have an excellent safety profile with no increased risk of retinal detachment or endothelial cell loss. Advancements have led to the introduction of extended depth of focus pIOLs for the correction of presbyopia, further research is required to evaluate the efficacy of new lens designs.

SUMMARY

pIOL surgery is experiencing traction with improved lens design and increased lenses choices such as larger optical zone and presbyopic options. Accuracy of implantable collamer lens sizing is paramount to the safety and clinical outcomes, greater predictability is likely to encourage more posterior chamber pIOL users due to fewer sizing related complications.

Effects of Decentration of Implantable Collamer Lens V4c on Visual Quality With the OPD-Scan III Aberrometer

PURPOSE

This study aimed to analyze the relationship between visual quality and implantable collamer lenses (ICL) decentration.

DESIGN

Prospective treatment evaluation clinical study METHODS: This prospective study included 119 eyes with ICL implantation. Refractive parameters and ocular aberrations were examined pre- and postoperatively. ICL decentration and higher-order aberrations (HOAs) were evaluated using the OPD-Scan III aberrometer.

RESULTS

At the 1-month follow-up, the mean values for decentration were 0.38 ± 0.19 mm (0.02-0.78). Regarding the position of decentration in right and left eyes, 22.8% and 17.7% were located in the superior nasal section, 0% and 6.5% in the inferior nasal section, 50.9% and 53.2% in the superior temporal section, and 26.3% and 22.6% in the inferior temporal section, respectively. The root mean square values of whole-eye total HOAs, coma, and trefoil had significantly increased. Decentration had a significant negative correlation with variation in the pre- and postoperative trefoils of the whole eye.

CONCLUSIONS

ICL decentration had a slightly negative correlation with trefoil and slightly affected visual quality.

The effect of irrigation and aspiration on the corneal endothelial cell density in patients undergoing Implantable Collamer Lens with a central hole implantation for myopia correction

PURPOSE

In the conventional technique, viscoelastic agents are typically rinsed away with balanced salt solution (BSS), but it may lead to a series of complications such as viscoelastic residue, anterior chamber instability and intraoperative TICL rotation. The utilization of irrigation and aspiration (I/A) has been shown to be effective in maintaining anterior chamber stability, reducing the incidence of postoperative high intraocular pressure, and minimizing postoperative fundus complications. However, there is a lack of previous studies investigating the impact of I/A on corneal endothelial cells during ICL implantation. The objective of this study was to examine the effect of I/A on corneal endothelial cells in patients undergoing myopia correction through implantation of Implantable Collamer Lens with a central hole (V4c ICL).

METHODS

A retrospective selection was made of 344 eyes from 172 patients who underwent V4c ICL implantation and I/A to remove viscoelastic agent from the anterior chamber between 2021 and 2022. The intraocular pressure (IOP) was measured at 1 h, 2 h and 3 h after surgery. Corneal endothelial cell density (ECD), coefficient of variation in cell size (CV), standard deviation of cell area (SD), and percentage of hexagonal cells (HEX) were evaluated at 1 week postoperatively to assess corneal endothelial cells. The first two represent polymegethism or morphological variation, while the third parameter represents the degree of polymorphism of the corneal endothelial cells. Electronic medical records were utilized for data collection purpose.

RESULTS

All surgeries proceeded without complications. The IOP was 16.50 ± 3.42 mmHg (range: 11.5-22.3 mmHg) prior to surgery and increased to 21.25 ± 5.61 mmHg (range: 9.5-34.8 mmHg), 19.85 ± 5.18 mmHg (range: 11.4-36.2 mmHg) and finally settled at an average of 18.81 ± 4.57 mmHg (range: 10.1-38.8 mmHg) at the respective time points of 1 h, 2 h and 3 h after surgery. The preoperative ECD was recorded as being approximately 3004 ± 295 cell/mm2, which exhibited a marginal decreased of 1.17% postoperatively, resulting in an average ECD value of 2969 ± 303 cell/mm2 one week after surgery (P = 0.12). Similarly, the preoperative CV was determined as 31.10 ± 3.78%, and it experienced a slight reduction with an average CV value of 30.74 ± 3.77% at week after surgery (P = 0.21). And, the preoperative SD was reported as 104.76 ± 17.26, and it remained virtually unchanged with an average SD value of 104.85 ± 18.75 at one week after surgery (P = 0.95). The preoperative HEX was calculated as 55.38 ± 8.94%, and it remained its stability with an average HEX value of 55.45 ± 8.73% one week after surgery (P = 0.92).

CONCLUSION

The utilization of I/A led to a slight decrease in postoperative ECD when compared to conventional surgical techniques. Nevertheless, the reduction in ECD remained within acceptable limits, taking into accout the avervantaged it offered, such as stabilization of the anterior chamber and decreased occurrence of viscoelastic residue after surgery. It is challenging to anticipate the long-term safety of corneal endothelial cells based on current short-term studies. However, this study provides a valuable reference indicating that neither anterior chamber irrigation nor I/A aspiration have an adverse impact on the safety of corneal endothelial cells in the short term. Further research is imperative to enhance our understanding of their effects over an extended period.

The rate of vault changes after ICL V4c implantation and its correlation with anterior segment parameters

Purpose

To investigate the rate of vault changes after implantation of ICL V4c and the correlation with anterior segment parameters.

Methods

A total of 64 eyes were studied from the 37 myopic subjects recruited. CASIA2 was used to record the vault at 1 week, 1 month, 3 months and 6 months after the operation as well as the preoperative anterior segment parameters including pupil diameter, lens vault, anterior chamber depth, anterior chamber width, iris area (IA), iris thickness, angle opening distance, angle recess area, trabecular iris space area, and trabecular iris angle. The rates of vault change in different time intervals were compared and the correlations between the rates and anterior segment parameters were analyzed. P < 0.05 was considered statistically significant.

Results

The rate of vault decrease was -19.53 ± 111.28 μm/month between 1 week and 1 month, -19.90 ± 29.71 μm/month between 1 month and 3 months and -4.25 ± 18.10 μm/month between 3 months and 6 months; hence the rate was shown to slow down significantly from 3 months post-operation (P = 0.024). The average rate of vault changes showed a significant positive correlation with IA (R2 = 0.140, F = 4.980, P = 0.01). No significant correlation was found with other anterior segment parameters (all P > 0.05).

Conclusion

The rate of decreasing vault significantly slowed down from 3 months post-operation. A larger IA may imply a lower decreasing rate of vault change.

Causes and management strategies for elevated intraocular pressure after implantable collamer lens implantation

With the widespread application of Implantable Collamer Lens (ICL) implantation surgery in the field of myopia correction, a comprehensive understanding of its potential complications, especially those related to intraocular pressure (IOP), becomes crucial. This article systematically reviews various complications that may lead to IOP elevation after ICL surgery. Firstly, common complications after ICL surgery, including residual viscoelastic, steroid response, and excessive vault of the ICL, are detailed, emphasizing their potential impact on intraocular pressure. Regarding residual viscoelastic, we delve into its direct relationship with postoperative elevated IOP and possible preventive measures. For steroid response, we stress the importance of timely adjustment of steroid therapy and monitoring intraocular pressure. Additionally, excessive vault of the ICL is considered a significant potential issue, and we elaborate on its mechanism and possible management methods. In further discussion, we focus on relatively rare complications such as Toxic Anterior Segment Syndrome (TASS), Urrets-Zavalia Syndrome (UZS), Pigment Dispersion Syndrome (PDS), and malignant glaucoma. For these relatively rare complications, this review thoroughly explores their potential mechanisms, emphasizes the importance of prevention, and provides guidance for early diagnosis and treatment. This is a comprehensible review that aims to offer eye care professionals a comprehensive understanding and effective management guidance for complications of elevated IOP after ICL surgery, ultimately providing optimal care for patients' visual health.

A Comprehensive Retrospective Analysis of EVO/EVO+ Implantable Collamer Lens: Evaluating Refractive Outcomes in the Largest Single Center Study of ICL Patients in the United States

Purpose

We evaluate visual outcomes in patients with EVO/EVO+™ (posterior chamber phakic intraocular lens with a central port) within approved United States (US) age and refractive range indications.

Patients and Methods

This single-center retrospective study evaluated one-month, single-center postoperative data for 225 eyes meeting inclusion criteria and undergoing EVO/EVO+ implantation from April to October 2022. Data included lens size (mm), lens power (diopters of spherical and cylindrical power), preoperative best corrected visual acuity, preoperative spherical equivalent from manifest refraction, achieved postoperative uncorrected visual acuity, postoperative refraction, intraocular pressure (mmHg), and adverse events.

Results

A total of 225 eyes underwent EVO/EVO+ Implantable Collamer Lens (ICL) implantation from April to October 2022, with 51.5% receiving toric lenses. The most common ICL size was 12.6mm (56.4%), followed by 13.2mm (27.5%), 12.1mm (15.1%), and 13.7mm (0.9%). Among patients with preoperative BCVA of 20/20 or better (149 eyes), 95.2% achieved postoperative UCVA of 20/20 or better, and 99.3% achieved UCVA of 20/25 or better at postoperative month one. About 75% of eyes were within a spherical equivalent target of ±0.50 D and 94% within ±1.00 D. Toric ICLs were implanted in 116 eyes (51.8%). Of these, anticipated residual cylinder >1 diopter was seen in 21 eyes (18.1%) resulting in three rotations, three explants, and three laser vision correction (LVC) enhancements. The postoperative adjustment rate (including rotations, exchanges, and LVC enhancement) was minimal (4.8%). Incidence of major adverse events was 0%.

Conclusion

Our study, the largest US single-center analysis of EVO/EVO+ ICL implantation, demonstrates strong early results and infrequent adverse events, supporting ICL safety and effectiveness. High predictability and favorable visual outcomes, including 20/20 or better, highlight the reliability of this technology. Despite study limitations, our findings underscore this technology's effectiveness. Future research should refine patient criteria and assess long-term outcomes in this evolving landscape.

Episodic Angle Closure after Visian™ Implantable Collamer Lens Implantation in a Patient Using Adderall®

Introduction

Amphetamine-based medications such as Adderall®, used for the treatment of attention deficit-hyperactivity disorder (ADHD), may theoretically elicit angle closure through their adrenergic mechanisms. The relationship between the use of implantable collamer lenses (ICLs) and angle closure has been extensively investigated based on appropriate vault and lens sizing and postoperative changes in the anterior chamber angle (ACA) and corneal morphology. This case reflects a synergistic impact from both Adderall® use and ICL implantation for the proposed mechanism of angle closure.

Case Presentation

A 36-year-old myopic female with ADHD controlled with Adderall® underwent toric ICL implantation in the right eye after undergoing preoperative laser peripheral iridotomy. Shortly after, the patient developed episodic angle closure in the right eye, with episodes mainly occurring after taking an additional dose of Adderall® in a dimly lit environment. The patient later had an ICL exchange with a smaller sized EVO+ toric ICL in the right eye and remained asymptomatic after.

Conclusion

Additive mechanisms from both the ICL and Adderall® were present in our patient. The ICL caused crowding of the ACA through a pseudophacomorphic mechanism, and the Adderall® caused increased iridotrabecular contact secondary to pharmacologic mydriasis. This resulted in episodic angle closure with subsequent spikes in the intraocular pressure. There are no current reports or studies in the current literature describing the combined mechanisms of ICL implantation and Adderall® use in the potential development of angle closure. Further studies may be done to assess interactions of such medications in patients after ICL implantation.

Refractive surgical correction and treatment of keratoconus

Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error. Intracorneal ring segments (ICRS) implantation represents a minimally invasive surgical option that improves visual acuity, with a high success rate and a low overall complication rate. Corneal allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial photorefractive or phototherapeutic keratectomy combined with CXL is another way in selected cases to improve spectacles corrected distance visual acuity. The microphotoablative remodeling of the central corneal profile is generally planned by optimizing the optical zones and minimizing tissue consumption. Phakic intraocular lens (PIOL) implant is considered in patients with stable disease and acceptable anatomical requirements. The two types of pIOLs, depending on their implantation inside the eye, are anterior chamber-pIOLs, which fixate to the anterior surface of the iris by using a polymethomethacrolate claw at the two haptics, and posterior chamber-pIOLs. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values. Toric IOL is recommended, but carefully judging the topography and the possible need of subsequent keratoplasties.

Assessment of the iridocorneal angle pigmentation and structures after the implantation of EVO+ Visian Implantable Collamer Lens

PURPOSE

To evaluate the effect of EVO+ Visian Implantable Collamer Lens (ICL) implantation on the iridocorneal angle pigmentation and structures.

METHODS

Myopic refractive surgery candidates who underwent posterior chamber EVO+ ICL implantation were evaluated preoperatively and 3 and 6 months postoperatively. High-resolution images of the iridocorneal angle (nasal, superior, temporal and inferior quadrants) were acquired during gonioscopy. A masked observer, blinded to study visits and patients' information, evaluated the angle width, apparent iris root insertion, iris configuration, and trabecular meshwork pigmentation according to the Spaeth scale in two different occasions. The intra-rater reliability was estimated using the weighted Gwet's Agreement Coefficient (AC2). Differences between visits were analyzed using the Cochran Q test or the Friedman test.

RESULTS

Twenty-one patients (13 females and 8 males) aging 31.3 ± 6.3 years old were recruited. The intra-rater reliability of gonioscopy assessment was excellent for every parameter assessed (AC2 ≥ 0.97). No significant differences were found among the study visits for any quadrant in the angle width (p ≥ 0.74), apparent iris root insertion (p ≥ 0.22), iris configuration (p ≥ 0.21) and trabecular meshwork pigmentation (p ≥ 0.24). Mean pigmentation of trabecular meshwork for the four quadrants did not vary either among visits (p = 0.25).

CONCLUSIONS

The EVO+ ICL implantation after uneventful procedures appears not to clinically affect the iridocorneal angle pigmentation and/or structures during a short-medium follow-up using gonioscopy assessment. The intra-rater reliability of glaucoma specialists assessing iridocorneal angle structures using gonioscopy images is very high.

Evaluation of ciliary body morphology and position of the implantable collamer lens in low-vault eyes using ultrasound biomicroscopy

PURPOSE

To investigate the ciliary body anatomy and position of the implantable collamer lens (ICL) in low-vault eyes and analyze factors related to insufficient vault.

SETTING

Zhongshan Ophthalmic Center, Guangzhou, China.

DESIGN

Retrospective case-control observational study.

METHODS

In this study, 73 eyes of 73 patients with an insufficient vault (<250 μm) were matched with 73 eyes with an ideal vault (250 to 750 μm). Ultrasound biomicroscopy was used to determine the ciliary body morphology and ICL position. The biometric parameters acquired by Scheimpflug tomography were compared. The correlation between the vault and these factors was analyzed, and the least absolute shrinkage and selection operator method was used to screen the risk factors for low vault.

RESULTS

The low-vault group had a steeper corneal curvature, thicker lens thickness (LT), higher crystalline lens rise, and shorter axial length (AL) (all P < .005). The ciliary process length (CPL) and maximum ciliary body thickness (CBTmax) were significantly smaller, and the trabecular-ciliary angle (TCA), iris-ciliary angle (ICA), and ciliary sulcus width (CSW) were significantly greater in the low-vault eyes (all P < .005). The low-vault group had more ICL haptics below the ciliary process, and TCA, ICA, CPL, CBTmax, CSW, and haptic position were related to the postoperative vault (all P < .05). CPL, AL, and LT were identified as predictors of a low vault.

CONCLUSIONS

Malposition of ICL haptics behind the ciliary process is a risk factor for low vault. A shorter CPL, thicker LT, and shorter AL are significant risk factors for the postoperative low vault.

The efficacy of 2 different phakic intraocular lens implant in keratoconus as an isolated procedure or combined with collagen crosslinking and intra-stromal corneal ring segments: a systematic review and meta-analysis

PURPOSE

To compare the efficacy of phakic intra-ocular lenses in isolation or in combination with corneal crosslinking (CXL) and/or intra-stromal corneal ring segments (ICRS) in keratoconus.

METHODS

Data extracted from the publications meeting the selection. The outcome parameters included mean pre- and post-operative uncorrected distance visual acuity, corrected distance visual acuity (CDVA), sphere and cylinder of refraction and complications. Available data analyzed with Cochrane Review Manager.

RESULTS

A total of 23 studies including 464 eyes were included. All the parameters showed significant improvement in all subgroups other than CDVA in ACPIOL + CXL subgroup and cylinder in PIOL + CXL subgroups. There was not a significant difference between PCPIOL and ACPIOL in the outcomes, exception was more improvement of CDVA in "ACPIOL only" than" PCPIOL only" subgroup.

CONCLUSION

Both PCPIOLs and ACPIOLs are comparably safe and efficient options in management of KCN and their efficacy significantly improves when combined with CXL/ICRS.

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.

Phakic intraocular Lens implantation in keratoconus patients

BACKGROUND

Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases.

AIM

To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards).

RESULTS

No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1.

CONCLUSION

pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

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.].

Case report: Spontaneous lens absorption after the implantation of an implantable collamer lens

Background

Spontaneous lens absorption is rare and usually occurs in eyes with certain syndromes, hyper-mature cataracts, and ocular trauma. The application of an implantable collamer lens (ICL) is widely performed in patients with high myopia for refractive correction. This study reports a case of spontaneous lens absorption after ICL implantation.

Case summary

A 23-year-old man was referred with complaints of poor vision in his left eye. The patient had undergone binocular ICL implantation for refractive correction of high myopia 1.5 years prior. Approximately 10 months later, he experienced a sudden loss of vision and pain in his left eye, which resolved spontaneously the next day without any treatment. Since then, the visual acuity in his left eye gradually decreased. At presentation, slit-lamp examination revealed an ICL in the posterior chamber of both eyes, with anterior capsular fibrotic proliferation and posterior capsular opacity, and the residual lens cortex sandwiched between the anterior fibrotic membrane and opacified posterior lens capsule in his left eye. The number of corneal endothelial cells in his left eye was 1,337, which was lower than before ICL implantation (2,902). The patient then underwent ICL extraction, anterior capsular capsulotomy, residual cortex aspiration, posterior capsular polishing, and intraocular lens implantation.

Conclusions

Spontaneous lens absorption may occur in patients with ICL implantation. Patients should undergo routine follow-ups after ICL implantation.

Three-Dimensional Quantitative Description of the Implantable Collamer Lens in the Ocular Anterior Segment of Patients With Myopia

PURPOSE

To describe the 3-dimensional (3D) location of the implantable collamer lens (ICL) quantitatively in the posterior ocular chamber of patients with myopia.

DESIGN

Cross-sectional study.

METHODS

To obtain visualization models before and after mydriasis, an automatic 3D imaging method based on swept-source optical coherence tomography was created. Parameters like the ICL lens volume (ILV), the tilt of the ICL and crystalline lens, the vault distribution index, and topographic maps were evaluated to describe the ICL location. Using a paired sample t test and the Wilcoxon signed rank test, the difference between nonmydriasis and postmydriasis conditions was compared.

RESULTS

The study investigated 32 eyes from 20 patients. The 3D central vault did not differ significantly before (P = .994) or after mydriasis (P = .549) compared with the 2D central vault. After mydriasis, the 5-mm ILV decreased by 0.85 mm2 (P = .016), and the vault distribution index increased significantly (P = .001). The ICL and the crystalline lens exhibited tilt (nonmydriasis: ICL total tilt 3.78 ± 1.85 degrees, lens total tilt 4.03 ± 1.53 degrees; postmydriasis: ICL total tilt 3.84 ± 1.56 degrees, lens total tilt 4.09 ± 1.64 degrees). The phenomenon of asynchronous tilt of the ICL and lens was found in 5 eyes, leading to the spatially asymmetric distribution of the ICL-lens distance.

CONCLUSION

The 3D imaging technique provided exhaustive and reliable data for the anterior segment. The visualization models offered multiple perspectives on the ICL in the posterior chamber. Before and after mydriasis, the intraocular ICL position was described by the 3D parameters.

Comparison of Dynamic Vault Changes Following Implantation of Two Different Models of Phakic Intraocular Lenses

PURPOSE

To compare the dynamic vault range (the difference in the central vault height from scotopic to photopic light condition) after implantation of the ICL/TICL (STAAR Surgical) and Eyecryl phakic/Eyecryl phakic toric intraocular lens (IOL) (Biotech Healthcare).

METHODS

This retrospective study included patients with myopia or myopic astigmatism eligible for phakic IOL implantation with either the ICL/TICL or Eyecryl phakic/Eyecryl phakic toric IOL. Vault changes in varying light conditions (scotopic, mesopic, and photopic) were assessed using an anterior segment optical coherence tomography-based tomographer and dynamic vault range (DVR) was compared between the two groups.

RESULTS

A total of 60 eyes from 36 patients (30 eyes in each group) with a mean age of 28.63 ± 6.36 years were included. The mean postoperative follow-up at the time of assessment was 9.4 ± 5.3 and 8.9 ± 5.28 months (P = .75) in the ICL and Eyecryl groups, respectively. The mean values of scotopic, mesopic, and photopic vault were 490.56 ± 238.64, 453.56 ± 224.30, and 373.96 ± 200.24 μm in the ICL group and 515.46 ± 174.34, 490.26 ± 184.04, 450.43 ± 173.92 μm in the Eyecryl group (P = .32, .24, and .05, respectively). The DVR was 116.6 ± 59.29 μm in the ICL group versus 65.03 ± 31.78 μm in the Eyecryl group (P < .001).

CONCLUSIONS

The Eyecryl phakic IOL showed significantly fewer light-induced changes in the central vault height (DVR) compared to the ICL, which may be attributed to the difference in the material of the two phakic IOL models. This may be clinically significant in eyes with low postoperative vaults with respect to their follow-up and risk assessment of cataractogenesis in the long term. [J Refract Surg. 2023;39(8):546-554.].

Four-year visual outcomes and optical quality of SMILE and implantable collamer lens V4c (EVO-ICL) implantation for high myopia: a retrospective study

BACKGROUND

To compare the 4-year visual outcomes of implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for high myopia and astigmatism.

METHODS

This retrospective case study included 64 eyes of 40 patients. These patients with preoperative manifest refraction spherical equivalent (SE) between - 6.00 and - 10.00 diopters (D) were screened from the database of SMILE and EVO-ICL implantation procedures in 2015. The ICL group [32 eyes of 19 patients (mean age, 29.6 ± 6.3 years); mean SE, -8.71 ± 1.06 D] and SMILE group [32 eyes of 21 patients (mean age, 27.7 ± 5.6 years); mean SE, -8.35 ± 0.65D] were compared. All patients were then prospectively examined at a four-year follow-up for routine postoperative examinations, higher-order ocular aberrations, retinal image quality and a questionnaire.

RESULTS

The safety indexes were 1.15 ± 0.14 and 1.22 ± 0.21 (P = 0.36) for the SMILE and ICL groups, respectively. No eyes lost two or more lines of CDVA in either group. The efficacy indexes were 0.97 ± 0.16 and 0.96 ± 0.19 (P = 0.87), respectively. Twenty-three eyes (72%) in ICL and 26 eyes (81%) in SMILE groups were within ± 0.5 D of the attempted SE (P < 0.01). ICL-treated eyes had significantly less spherical aberration and coma (P < 0.01 and < 0.05, respectively) postoperatively. Halos were the prevalent visual disturbance in both groups.

CONCLUSION

SMILE and EVO-ICL implantation provided safe and effective correction of high myopia. SMILE showed slightly better long-term predictability. Mild postoperative visual disturbances were observed after ICL and SMILE at 4-year follow-up.

Flexural and Cell Adhesion Characteristic of Phakic Implantable Lenses

Background and Objectives: In this study, we aimed to compare the physical properties of hole-implantable collamer lenses (H-ICLs) and implantable phakic contact lenses (IPCLs) and investigate their flexural and cell adhesion characteristics. Materials and Methods: Transverse compression load to achieve lens flexion and static Young's modulus were measured in H-ICLs and IPCLs using designated equipment. Load was measured both with and without restraining the optic section of the lenses. Adhesion of iHLEC-NY2 cells to the lens surfaces was examined using phase-contrast microscopy, and cell proliferation activity was evaluated using WST-8 assay. Results: The H-ICL showed a greater tendency for transverse compression load compared to IPCL, while the IPCL showed a higher Young's modulus with respect to the force exerted on the center of the anterior surface of the optic section. The joint between the optic section and haptic support in the IPCL was found to mitigate the effects of transverse compression load. Both lens types showed minimal cell adhesion. Conclusions: Our findings indicate that H-ICLs and IPCLs exhibit distinct physical properties and adhesive characteristics. The IPCL demonstrated higher Young's modulus and unique structural features, while the H-ICL required greater transverse compression load to achieve the flexion required to tuck the haptic supports into place behind the iris to fix the lens. The observed cell non-adhesive properties for both lens types are promising in terms of reducing complications related to cell adhesion. However, further investigation and long-term observation of IPCL are warranted to assess its stability and potential impact on the iris. These findings contribute to a better understanding of the performance and potential applications of H-ICLs and IPCLs in ophthalmology.

Predictability of the vault after implantable collamer lens implantation using OCT and artificial intelligence in White patient eyes

PURPOSE

To compare the predicted vault using machine learning with the achieved vault using the online manufacturer's nomogram in patients undergoing posterior chamber implantation with an implantable collamer lens (ICL).

SETTING

Centro Oculistico Bresciano, Brescia, Italy, and I.R.C.C.S.-Bietti Foundation, Rome, Italy.

DESIGN

Retrospective multicenter comparison study.

METHODS

561 eyes from 300 consecutive patients who underwent ICL placement surgery were included in this study. All preoperative and postoperative measurements were obtained by anterior segment optical coherence tomography (AS-OCT; MS-39). The actual vault was quantitatively measured and compared with the predicted vault using machine learning of AS-OCT metrics.

RESULTS

A strong correlation between model predictions and achieved vaulting was detected by random forest regression (RF; R2 = 0.36), extra tree regression (ET; R2 = 0.50), and extreme gradient boosting regression ( R2 = 0.39). Conversely, a high residual difference was observed between achieved vaulting values and those predicted by the multilinear regression ( R2 = 0.33) and ridge regression ( R2 = 0.33). ET and RF regressions showed significantly lower mean absolute errors and higher percentages of eyes within ±250 μm of the intended ICL vault compared with the conventional nomogram (94%, 90%, and 72%, respectively; P < .001). ET classifiers achieved an accuracy (percentage of vault in the range of 250 to 750 μm) of up to 98%.

CONCLUSIONS

Machine learning of preoperative AS-OCT metrics achieved excellent predictability of ICL vault and size, which was significantly higher than the accuracy of the online manufacturer's nomogram, providing the surgeon with a valuable aid for predicting the ICL vault.

Evaluation of Ocular Diameter Parameters Using Swept-Source Optical Coherence Tomography

Purpose: To investigate the iridocorneal angle-to-angle (ATA), sclera spur-to-sclera spur (STS), and white-to-white (WTW) ocular diameters and their potential influence on anterior chamber intraocular lens (ACIOL) and implantable collamer lens (ICL) sizing in Chinese subjects by using a swept-source optical coherence tomography system (SS-OCT). Design: A retrospective, observational, cross-sectional study. Methods: In 60 right eyes (60 subjects), the ATA, STS, and WTW were measured in six axes (0°-180°, 30°-210°, 60°-240°, 90°-270°, 120°-300°, and 150°-330°) using SS-OCT. The ACIOL and ICL sizes were calculated based on horizontal and vertical axes anterior segment data. A paired sample t-test was used to test the differences in each parameter across the six axes, the potential difference between each pair of parameters in a given axis, and the artificial lens size difference between the horizontal and vertical directions. Pearson's correlation analysis was used to determine the potential correlation between age and AL, WTW, STS, and ATA distances. Results: ATA and STS were the longest on the vertical and shortest on the horizontal axis, while WTW was similar on both axes. These three parameters differed only in the vertical axis (F = 4.910, p = 0.008). ATA and STS were by 0.23 ± 0.08 mm (p = 0.005) and 0.21 ± 0.08 mm wider (p = 0.010) than WTW, respectively. ICL size was 0.27 ± 0.23 mm smaller when based on the horizontal than on the vertical axis parameters (p < 0.001), while ACIOL remained similar (p = 0.709). Age correlated negatively and axial length positively with all measured values. ATA, STS, and WTW correlated positively in the same axis (all p < 0.001). Conclusions: ATA and STS were longer in the vertical than in the horizontal direction, while WTW measurements remained similar. ATA and STS diameters more accurately depicted anatomic relationships for phakic IOL sizing than WTW.

The Non-uniform Distribution of Horizontal and Vertical Crystalline Lens Rise Using Optical Coherence Tomography

PURPOSE

To observe the crystalline lens rise (CLR) in horizontal and vertical orientations using anterior segment optical coherence tomography (AS-OCT).

METHODS

Non-invasive swept-source AS-OCT was used to measure the lens thickness, CLR, and angle-to-angle distance (ATA) in both the horizontal and vertical orientations. Anterior chamber depth (ACD) and horizontal white-to-white corneal diameter were obtained using the Pentacam HR (Oculus Optikgeräte GmbH). Axial length was obtained using the IOLMaster 700 (Carl Zeiss Meditec AG). The paired t test was used to analyze the difference in CLR between the two orientations. Pearson correlation analysis was performed to investigate the correlations between CLR and other ocular variables.

RESULTS

This prospective observational study comprised 99 eyes (99 patients) that underwent Visian Implantable Collamer Lens (STAAR Surgical) implantation for myopic correction. The mean CLR was 64.29 ± 168.04 and 208.09 ± 173.12 µm in the horizontal and vertical orientations, respectively. The vertical CLR (VCLR) was significantly greater than the horizontal CLR (HCLR) (P < .05). Both the HCLR and VCLR were positively correlated with lens thickness and negatively correlated with ACD (all P < .05). The difference in CLR (VCLR-HCLR) was positively correlated with the axial length and the difference in ATA between the two orientations (P < .05).

CONCLUSIONS

VCLR was greater than HCLR in most patients with myopia, especially in the longer eyes. This nonuniform distribution in CLR implied different placements of the iridocorneal angles in the horizontal and vertical orientations and should be considered for the selection of ICL size and placement position. [J Refract Surg. 2023;39(5):354-359.].

Artificial intelligence-based refractive error prediction and EVO-implantable collamer lens power calculation for myopia correction

BACKGROUND

Implantable collamer lens (ICL) has been widely accepted for its excellent visual outcomes for myopia correction. It is a new challenge in phakic IOL power calculation, especially for those with low and moderate myopia. This study aimed to establish a novel stacking machine learning (ML) model for predicting postoperative refraction errors and calculating EVO-ICL lens power.

METHODS

We enrolled 2767 eyes of 1678 patients (age: 27.5 ± 6.33 years, 18-54 years) who underwent non-toric (NT)-ICL or toric-ICL (TICL) implantation during 2014 to 2021. The postoperative spherical equivalent (SE) and sphere were predicted using stacking ML models [support vector regression (SVR), LASSO, random forest, and XGBoost] and training based on ocular dimensional parameters from NT-ICL and TICL cases, respectively. The accuracy of the stacking ML models was compared with that of the modified vergence formula (MVF) based on the mean absolute error (MAE), median absolute error (MedAE), and percentages of eyes within ± 0.25, ± 0.50, and ± 0.75 diopters (D) and Bland-Altman analyses. In addition, the recommended spheric lens power was calculated with 0.25 D intervals and targeting emmetropia.

RESULTS

After NT-ICL implantation, the random forest model demonstrated the lowest MAE (0.339 D) for predicting SE. Contrarily, the SVR model showed the lowest MAE (0.386 D) for predicting the sphere. After TICL implantation, the XGBoost model showed the lowest MAE for predicting both SE (0.325 D) and sphere (0.308 D). Compared with MVF, ML models had numerically lower values of standard deviation, MAE, and MedAE and comparable percentages of eyes within ± 0.25 D, ± 0.50 D, and ± 0.75 D prediction errors. The difference between MVF and ML models was larger in eyes with low-to-moderate myopia (preoperative SE >  - 6.00 D). Our final optimal stacking ML models showed strong agreement between the predictive values of MVF by Bland-Altman plots.

CONCLUSION

With various ocular dimensional parameters, ML models demonstrate comparable accuracy than existing MVF models and potential advantages in low-to-moderate myopia, and thus provide a novel nomogram for postoperative refractive error prediction and lens power calculation.

Two-year stability of posterior corneal surface after transepithelial photorefractive keratectomy with a residual stromal thickness less than 350 μm

PURPOSE

This study aimed to investigate the stability of posterior corneal surface 2 years after transepithelial photorefractive keratectomy (TPRK) in patients with a residual stromal thickness less than 350 μm.

METHODS

In total, 408 eyes of 212 patients (160 women, 52 men) who underwent TPRK were enrolled in this retrospective study. All surgeries were performed in the Amaris 750S excimer laser platform with smart pulse technology. The posterior corneal elevation, anterior chamber depth, Q value, and curvature were measured using Pentacam preoperatively and postoperatively. All patients were followed up for 2 years. The relationship between percent tissue altered (PTA), age, and changes in posterior corneal surface was analyzed.

RESULTS

The mean preoperative spherical equivalent was - 6.80 ± 1.18 D (range: - 9.00 to - 2.63 D). The mean residual stromal thickness was 336.46 ± 7.25 μm (range: 310-348 μm). The mean PTA was 30.93 ± 2.03% (range: 24.29-35.28%). At 2 years after surgery, the elevation of six points in the central area decreased by 1.91 ± 2.97 μm, 2.98 ± 3.23 μm, 1.17 ± 3.85 μm, 1.70 ± 2.88 μm, 1.36 ± 3.19 μm, and 1.65 ± 3.18 μm, compared with the preoperative value (P < 0.05). The elevation of three points in the peripheral area increased by 1.87 ± 6.34 μm, 0.68 ± 6.00 μm, and 0.95 ± 5.50 μm (P < 0.05). There was no significant linear relationship between PTA, age, and changes in posterior corneal surface, anterior chamber depth, and K2 (all P > 0.05).

CONCLUSION

Within 2 years after TPRK, the posterior corneal surface remained stable in patients with a residual stromal thickness between 310 and 350 μm. There was no sign of iatrogenic ectasia during the follow-up period.

ICL Postimplantation Decentration and Tilt in Myopic Patients with Primary Iridociliary Cysts

Purpose

To observe the decentration and tilt of implantable collamer lens (ICL) as well as possible visual effects postimplantation in primary iridociliary cysts.

Methods

The present investigation was a retrospective cohort study. All 48 patients (91 eyes) who underwent ICL surgery at the Center of Refraction Surgery of Tianjin Medical University Eye Hospital between July 2018 and May 2020 were split into two groups based on the absence or presence of primary iridociliary cysts established by ultrasonic biological microscopy (UBM) examination. Intraocular pressure (IOP), corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior chamber angle (ACA), anterior chamber volume (ACV), and anterior chamber depth (ACD) were recorded preoperatively and postoperatively at 1, 6, and 12 months. Additionally, we performed an analysis of the ICL vault, decentration, and tilt using a rotating Scheimpflug Oculus Pentacam camera system at 1, 6, and 12 months after surgery.

Results

No serious complications were observed. Significant postoperative improvement (P < 0.05) of UDVA was established in the two studied groups; however, we did not observe statistically significant intergroup differences (P > 0.05) throughout the entire research period. In each group, the preoperative ACA, ACV, and ACD were statistically significantly reduced (P < 0.05), but no such decrease was established between their postoperative values (P > 0.05). We observed no statistical differences between both groups with regard to their values of IOP, ACA, ACV, ACD, ICL vault, ICL decentration, and tilt at 1, 6, and 12 months after surgery. Similarly, no statistically significant within-group correlation (P > 0.05) of the decentration of ICL and the tilt and the CDVA values was established.

Conclusion

No postimplantation effect of ICL with a central hole on vision was established in myopia patients with primary iridociliary cysts, within certain limits of ICL decentration and tilt values.

Postoperative efficacy, safety, predictability, and visual quality of implantable collamer lens implantation versus small incision lenticule extraction in myopic eyes: a Meta-analysis

AIM

To compare the postoperative efficacy, safety, predictability, and visual quality of implantable collamer lens (ICL) implantation versus small incision lenticule extraction (SMILE) in myopia eyes.

METHODS

PubMed, EMBASE, Web of Science, Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia. The primary outcomes were efficacy, safety, and predictability. And the secondary outcomes were postoperative higher-order ocular aberrations (HOAs), modulation transfer function cutoff frequency (MTF), objective scatter index (OSI), contrast sensitivity and a quality of vision (QoV) questionnaire.

RESULTS

A total of 1036 eyes from 10 studies, of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE, were enrolled in this Meta-analysis. Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity (CDVA) (P=0.007, <0.00001, respectively), and a lower percentage of eyes with a postoperative CDVA lost 1 line (P=0.007) than the SMILE group. No significant differences were found in comparison of the other primary outcomes. In the long-term follow-up (>6mo), ICL group had a lower total HOA, coma, and spherical aberration than SMILE group (P=0.003, <0.00001, 0.04). Yet higher trefoil was found in ICL group at 6mo after surgery (P=0.003). Additionally, ICL group also had a higher MTF value (P=0.02), and a higher contrast sensitivity score for spatial frequencies of 1.5, 6, and 12 cpds (P=0.02, 0.005, 0.02, respectively). And it also had a lower score of bothersome in QoV questionnaire than SMILE group (P=0.003).

CONCLUSION

ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia. However, ICL group is relatively safer and also has better visual quality in comparison of SMILE group.

Implantable Collamer Lens Use in a Spaceflight Participant During Short Duration Spaceflight

BACKGROUND: The purpose of this report is to document the first use of a single piece, posterior chamber phakic implantable collamer lens (ICL) with a central port in the right eye (OD) of a spaceflight participant (SFP) during a 12-d Soyuz mission to the International Space Station (ISS). We also briefly document the stability of a pre-existing pachychoroid pigment epitheliopathy (PPE) in the macula of his left eye (OS) during this mission.CASE REPORT: Ocular examination, including refraction, slit lamp examination, macular examination by optical coherence tomography (OCT), and tonometry were performed before and after his mission and he was questioned regarding visual changes during each portion of his flight.DISCUSSION: We documented no change in ICL position during his spaceflight. He reported stable vision during liftoff, entry into microgravity, 12 d on the ISS, descent, and landing. Our results suggest that the modern ICL with a central port is stable, effective, and well tolerated during short duration spaceflight. His PPE also remained stable during this mission as documented by OCT.Gibson CR, Mader TH, Lipsky W, Brown DM, Jennings R, Law J, Sargsyan A, Brunstetter T, Danilichev SN, Maezawa Y. Implantable collamer lens use in a spaceflight participant during short duration spaceflight. Aerosp Med Hum Perform. 2023; 94(1):48-50.

Posterior-Chamber Phakic Implantable Collamer Lenses with and without a Central Hole: A Comparative Study

Purpose

 This study aimed to compare the short-term outcome of implanting the Visian implantable collamer lens V4 ICL versus the Visian V4c ICL in patients with moderate and high myopia.

Patients and Methods

 This is a retrospective that was conducted on patients with moderate or high myopia who were scheduled for ICL implantation at our institution, Patients who underwent V4 ICL implantation with peripheral iridectomy were assigned to group A, and those who underwent V4c ICL implantation without peripheral iridectomy were assigned to group B. In group A, a preoperative peripheral iridectomy was performed. In group B, the patients received cycloplegic and dilating agents. The patients underwent a complete ocular examination preoperatively and during the follow-up visits that were conducted at 3, 6, and 12 months postoperatively.

Results

This study included 214 eyes from 107 patients; group A included 110 eyes, and group B included 104 eyes. Postoperatively, the UCVA and BCVA showed statistically significant improvement across the follow-up time points (p<0.001), with no significant difference between the two groups. No statistically significant difference was found between the two groups in the mean achieved correction or the residual refraction. Both groups showed a strong correlation between the target and the achieved correction, with R2 = 0.99 in the two groups. No significant difference was found between the two groups in the IOP across all time measures. However, the intraocular pressure showed a statistically significant postoperative increase in group A (p=0.004), and no significant change in group B (p=0.817). There was a downward slope in the vaults of both groups across time, with significant variation in the last follow-up measure compared to the 3-month measure in the two groups (p<0.001). No significant difference was found between the two groups across all time measures.

Conclusion

The current study adds new evidence concerning the feasibility, safety, and efficacy of ICL V4c implantation for the treatment of moderate and high myopia, with safer postoperative IOP.

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.

Visual Acuity Improvement in Low, Moderate and High Myopia After Posterior-Chamber Phakic Implantable Collamer Lens Surgery in a Large Patient Cohort

Purpose

To compare best-corrected visual acuity (BCVA) before and after implantable collamer lens (ICL) surgery in patients with low, moderate and high myopia.

Methods

A single-centre, prospective, registry-based study involving patients with myopia who received ICLs between October 2018 and August 2020. The study population was divided into three groups of subjects with low (from 0 to -6 D), moderate (-6 to -10 D) and high myopia (more than -10 D). We analysed uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent (SE), differences between BCVA pre- and 1-month postoperative, and line gain in BCVA 1 month after surgery.

Results

A total of 770 eyes belonging to 473 patients were surgically intervened during the study period, of which 692 eyes completed 1 month of postoperative follow-up and were included in the study population. At 1-month follow-up, 478 eyes (69%) achieved a BCVA of 20/20, 599 (87%) obtained 20/25 or better, and 663 (96%) had a BCVA of 20/40 or better. We identified a significant improvement in BCVA (baseline 0.15±0.2 logMAR vs follow-up 0.07±0.2 logMAR, p<0.0001) and a significant reduction in SE (baseline -9.23±4.1 D, vs follow-up -0.21±0.8 D, p<0.0001), with a significant relationship between preoperative SE and line gain (r = -0.46, p<0.0001). We identified a significantly higher line gain among eyes with higher degrees of myopia (low myopia 0.22±0.69 lines compared to moderate myopia 0.56±1.1 lines and high myopia 1.51±1.9 lines, p<0.0001). Notably, 99.6% of eyes with a high grade of myopia achieved improvement to a low degree (less than -6 D) at follow-up. The safety and efficacy indexes were 0.083±0.1 and -0.001±0.1, respectively.

Conclusion

In this large patient cohort, ICL surgery was related to a significant line gain in BCVA, particularly among eyes with higher degrees of myopia.

Corneal endothelial ring following the implantation of toric implantable collamer lenses with a central hole: a case report

BACKGROUND

To report a case of a corneal endothelial ring after toric implantable collamer lens (TICL, V4C) implantation in the right eye of a patient.

CASE PRESENTATION

A 36-year-old woman with refractive errors of -8.00 DS/-2.00 DC * 8° in the right eye and - 6.50 DS/-1.75 DC * 177° in the left eye developed a corneal endothelial ring in the right eye on the first day after receiving TICLs implantation for treatment of high myopic astigmatism, which has not been previously reported as a complication of ICLs implantation. At 1 day postoperatively, the uncorrected distance visual acuity (UDVA) was 20/16, the intraocular pressure as measured by non-contact tonometry was 16.9 mmHg, and the vault as measured by anterior segment optical coherence tomography was 1238 μm. The eye was quiet and there was no unusual anterior chamber reaction. However, slit-lamp examination revealed an endothelial annular lesion of approximately 0.4 mm in diameter in the central part of the cornea, which was gray-white in color. The shape of the ring was the same as that of the central hole of the TICL. Specular microscopy showed that the mean endothelial cell density (ECD) of the ring significantly decreased to 1442 ± 263 cells/mm², while the other part was still normal (2852 ± 103 cells/mm²). After 9 days of corticosteroid treatment and intense lubrication, the patient had a clear cornea, increased ECD (1532 ± 653 cells/mm²), and a good UDVA (20/16).

CONCLUSION

This case suggests that a few hours after ICL V4C implantation, with a large vault, corneal displacement caused by an air puff would make the endothelium close to or even contact the ICL, producing a corneal endothelial ring. After ruling out various possible factors, we speculated that the endothelial ring was developed due to the non-contact tonometer air puff before slit-lamp evaluation, and this phenomenon was recorded by Corvis, which confirmed that the cornea could come in contact with the ICL due to gas shock. This "contact" may cause transient corneal endothelial damage.

The EVO ICL for Moderate Myopia: Results from the US FDA Clinical Trial

Purpose

To evaluate the safety and effectiveness of collamer posterior chamber phakic refractive lenses with a central port design (EVO and EVO+ Sphere and Toric implantable collamer lenses [ICLs]) for correction of moderate myopia with or without astigmatism.

Patients and Methods

Six-month results of a multicenter clinical trial were performed under United States FDA Investigational Device Exemption. Subjects 21 through 45 years of age with manifest refraction spherical equivalent ranging from -3.00 D to -6.00 D and astigmatism up to 4.00 D underwent implantation of EVO or EVO+ Sphere or Toric ICLs. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, intraocular pressure (IOP), endothelial cell density, and adverse events were evaluated over 6 months.

Results

This report includes a retrospective review of 200 eyes of 114 subjects with mean age 35.1 ± 5.1 years that completed the 6-month visit. Mean preoperative spherical equivalent (SE) measured -4.61 ± 0.87 D (range: -3.00 to -6.00 D). At 6 months, mean SE was -0.085 ± 0.26 D, with 91.5% within ± 0.50 D of target and 100.0% within ±1.00 D of target. Mean postoperative UDVA and CDVA were -0.065 ± 0.08 logMAR and -0.14 ± 0.07 logMAR, respectively. About 98.0% of eyes maintained or gained lines of CDVA, and no eye lost more than 1 line CDVA. Efficacy and safety indices were 1.03 and 1.21, respectively. No eye experienced pupillary block, required preoperative or postoperative peripheral iridotomy or iridectomy, developed anterior subcapsular cataract or had elevated IOP due to angle narrowing or pigment dispersion. Mean endothelial cell density declined by 2.2%.

Conclusion

EVO ICL lenses demonstrated accuracy, predictability and stability of refractive correction with achievement of high levels of UDVA and an excellent safety profile for patients with moderate myopia with or without astigmatism.

Descriptive Analysis of Footplate Position After Myopic Implantable Collamer Lens Implantation Using a Very High-Frequency Ultrasound Robotic Scanner

Purpose

To assess the position of the haptics of the implantable collamer lens (ICL) in myopic eyes using a high-frequency ultrasound robotic scanner.

Methods

This was a prospective, single-arm, observational study carried out at the Instituto Zaldivar SA (Mendoza, Argentina) in a sample of 52 eyes who have been submitted to successful ICL implantation prior to enrollment. Images of the eyes were obtained using a very-high frequency digital ultrasound robotic scanner (VHFDU) to establish the position of the ICL in the posterior chamber and its relation to the ciliary sulcus. New parameters for lens position analysis were also described.

Results

In 81% of cases (42 eyes), the ICL rests on the ciliary body (CB) in both temporal and nasal sides, being slightly lower than 6% (3 eyes) those that rest on the sulcus in both sides, with significant correlations between ICL position and vault values (p<0.05). Cases in which the ICL position was CB-CB yielded central vault values across the whole range determined within the sample, but most of the eyes where the ICL rests on both the sulcus in one side and the CB in the other yield greater central vault values. Correlation was significant between ICL position and retroposition distance on the temporal side (Spearman's rho -0.487, p<0.001). A significant but weaker correlation was also found between ICL position and retroiridian space (p<0.05).

Conclusion

ICL for myopia footplates tend to locate outside of the sulcus in a significant percentage of patients after successful implantation. VHFDU assessment in eyes implanted with an ICL to properly study the lens footplate position and posterior anatomical relations provides important additional information besides post-surgery vault.

The effect of implantable collamer Lens V4c on ocular biometric measurements and intraocular lens power calculation based on Pentacam-AXL and IOLMaster 500

Background

To investigate the possible effect of implantable collamer lens (ICL) V4c on ocular biometric measurements by a new biometer Pentacam-AXL and partial coherence interferometry (PCI)-based IOLMaster 500 and intraocular lens power calculation using fourth-generation formula.

Methods

We retrospectively enrolled patients who underwent ICL (EVO-V4c, STAAR Surgical Co. Nidau, Switzerland) implantation surgery from September 2020 to November 2021. The Pentacam-AXL and IOLMaster 500 biometers were used to measure axial length (AL), anterior chamber depth (ACD), keratometry (K), white to white (WTW), and central corneal thickness (CCT) values before and at least 2 months after ICL V4c implantation. The IOL power was calculated using the Barrett Universal II formula.

Results

The study included 45 eyes in 28 patients. There was a significant increase in ALs (average 0.03 ± 0.07 mm, p = 0.01) and a significant decrease of ACDs (average 0.19 ± 0.17 mm, p < 0.001) based on Pentacam-AXL. Similar changes in ALs and ACDs were also found in IOLMaster 500. In addition, the difference in WTWs in the two devices and that of CCTs in Pentacam-AXL were statistically significant. However, the preoperative and postoperative K1 and K2 were separately comparable using either device. The IOL power calculated by the Barrett Universal II formula did not change significantly either by the software built in Pentacam-AXL or by manually putting the parameters of the IOLMaster 500 into the formula manually (p = 0.058, p = 0.675, respectively).

Conclusions

Ocular parameters including ALs, ACDs, WTWs, and CCTs using a new Pentacam-AXL and standard PCI-based IOLMaster 500 changed significantly before and after the ICL V4c implantation, while IOL power prediction using the Barrett Universal II formula was little affected.

Inter-eye and postoperative prediction of vault after implantation of EVO + Visian phakic implantable collamer lens

PURPOSE

To assess whether the postoperative outcomes of the implantation of an EVO + implantable collamer lens (ICL) in one eye can be used as a predictor of the vault of the fellow eye, and to evaluate the vault changes of the implantation in both eyes during the postoperative period.

METHODS

A prospective study including 40 eyes of 20 patients with a bilateral EVO + ICL implantation was performed. Subjects were evaluated before the surgery and 1 day, 1 week and 1, 3 and 6 months postoperatively. Central vault was assessed using spectral-domain optical coherence tomography. The inter-eye and follow-up analyses were performed using lineal models and the Bland-Altman method.

RESULTS

The vault of the first implanted eye at the 1-day visit highly predicts the vault of the second eye (R² = .87; P < .001); the mean inter-eye difference was - 0.95 μm, and the superior and inferior limits of agreement were -50.27 μm and 148.37 μm, respectively. This relationship was maintained during the medium-term follow-up, not finding differences in the slopes among visits (P ≥ .09). A progressive decrease of vault was found during the follow-up (P < .001). Larger vault change 6 months after the surgery was associated with higher vault 1 day after the ICL implantation (R² = .19;P = .005).

CONCLUSION

One-day postoperative vault in the first eye can help to predict the optimal ICL sizing in the second eye. Vault tends to decrease during the first 6 months after EVO + ICL implantation. Eyes with higher initial vaults will also show larger reductions during the medium-term follow-up.