Anterior Subcapsular Opacities and Cataracts 5 Years After Surgery in the Visian Implantable Collamer Lens FDA Trial

Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report

BACKGROUND

Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management.

CASE PRESENTATION

A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0.

CONCLUSIONS

Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

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.

The Effects of Implantable Collamer Lens ICL Implantation in High Myopia Patients' Mental Health

Purpose

To investigate the psychological changes in patients pre and post implantable collamer lens (ICL, EVO) implantation surgery in the posterior chamber.

Patients and methods

Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the mental states of 43 patients who underwent ICL implantation surgery performed by the same surgeon between January 2021 and December 2022.

Results

Comparing the results before and one week after the operation, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). Similarly, when comparing the pre-operation and one-month post-operation results, there is also a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). However, when comparing the one-week post-operation and one-month post-operation results, there is no significant difference in either the SAS scale (P>0.05) or the SDS scale (P>0.05). Moving on to the comparison between the pre-operation results and the national norm level, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). When comparing the one-week post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). Similarly, when comparing the one-month post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05).

Conclusion

After undergoing ICL implantation surgery, patients typically experience a notable decrease in anxiety (SAS) and depression (SDS) scales. These improvements gradually stabilize and enhance during the postoperative recovery period. However, it may require a significant amount of time for patients to fully restore their psychological well-being to levels comparable to the national norm, particularly in terms of anxiety levels.

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.

Diagnostic Techniques to Increase the Safety of Phakic Intraocular Lenses

Preoperative and postoperative diagnostics play an important role in ensuring the safety of patients with phakic intraocular lenses (pIOLs). The risk of endothelial cell loss can be addressed by regularly measuring the endothelial cell density using specular microscopy and considering the endothelial cell loss rate and the endothelial reserve in accordance with the patient's age when deciding whether to explant a pIOL. The anterior chamber morphometrics, including the anterior chamber depth and the distance between the pIOL and the endothelium, measured using Scheimpflug tomography and anterior segment optical coherence tomography (AS-OCT), can help to assess the risk of the endothelial cell loss. In patients undergoing posterior chamber pIOL implantation, accurate prediction of the vault and its postoperative measurements using AS-OCT or Scheimpflug tomography are important when assessing the risk of anterior subcapsular cataract and secondary glaucoma. Novel approaches based on ultrasound biomicroscopy and AS-OCT have been proposed to increase the vault prediction accuracy and to identify eyes in which prediction errors are more likely. Careful patient selection and regular postoperative follow-up visits can reduce the complication risk and enable early intervention if a complication occurs.

Development and validation of a new multivariable prediction model to estimate risk of abnormal vault

PURPOSE

To develop and validate a new multivariable prediction model to estimate risk of abnormal vault after EVO Implantable Collamer Lens (EVO-ICL) implantation using the preoperative parameters.

METHODS

This retrospective study comprised 282 eyes of 143patients who underwent EVO-ICL surgery between May 2021 and April 2022. We measured preoperative parameters before surgery and vaults in 1 week after the operation using swept-source optical coherence tomography (SS-OCT). Risk factors for abnormal vault were determined by univariate and multivariate logistic regression analyses, and a nomogram was developed to forecast the risk of abnormal vault after EVO-ICL implantation. We assessed the performance of nomogram in terms of discrimination and calibration, including concordance index (C-index), receiver operating characteristic curve (ROC), area under the ROC curve (AUC), and decision curve analysis (DCA). Bootstrap resampling was used as an internal verification method.

RESULTS

The logistic regression analysis revealed the independent risk factors for abnormal vault were white-to-white(WTW), anterior chamber angle(ACA), pupil size, and ICL-size, all of them were used to establish a nomogram based on multivariate logistic regression to predict the risk of abnormal vault. The C-indexes and AUC were 0.669 (95%CI, 0.605, 0.733). The calibration curves of the nomogram showed relatively small bias from the reference line, implicating an acceptable degree of confidence. The DCA indicates the potential clinical significance of the nomogram.

CONCLUSIONS

We developed a new multivariable prediction model to estimate risk of abnormal vault. The model shows good prediction effect and can provide assistance for clinical decision of ICL size.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

PURPOSE

To introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL.

METHODS

We searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years.

RESULTS

ICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications.

CONCLUSION

There are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.

Comparison of white-to-white measurements using four devices and their determination of ICL sizing

BACKGROUND

To compare the measurements obtained from the Orbscan II, IOLMaster 700, Pentacam AXL, and Castroviejo caliper and their effects on calculating the recommended implantable collamer lens (ICL) size and postoperative vault measurements.

METHODS

This is a retrospective cross-sectional study of patients who underwent ICL surgery by a single surgeon from March 1, 2018 to July 31, 2021. Records were reviewed for the anterior chamber depth (ACD) and white-to-white (WTW) measurements obtained from the Orbscan II, IOLMaster 700, Pentacam AXL, and Castroviejo caliper (WTW only). These were used to calculate the recommended ICL size. The actual ICL size implanted, and vault measurements obtained one month postoperatively were also collected.

RESULTS

One hundred seven eyes with a mean age of 27.9 ± 7.7 years were included in the study. Mean WTW measurements were significantly different between devices (P < 0.0001), with the IOLMaster 700 having the highest value (12.14 ± 0.04 mm) and the caliper having the lowest value (11.45 ± 0.04 mm). Mean ACD measurements were the lowest in Orbscan II (3.12 ± 0.25 mm) and the highest in Pentacam AXL (3.16 ± 0.24 mm). The Pentacam AXL produced an ICL size similar to the Orbscan in 69.2% of eyes. The IOLMaster yielded an ICL measurement one size larger than Orbscan-based calculations in 64.5% of eyes. Using the Orbscan WTW and ACD, the desired vault of 0.25 to 0.75 mm and 0.25 to 1.00 mm was achieved in 70% and 91% of eyes, respectively. Substituting caliper WTW to IOLMaster 700 or Pentacam AXL WTW increases the percentage of achieving the desired vault to 80%, similar to the Orbscan.

CONCLUSIONS

The Orbscan II, IOLMaster 700, and Pentacam AXL cannot be used interchangeably for calculating ICL sizing. Combining the WTW from caliper measurement with the ACD of the IOLMaster 700 or Pentacam AXL could improve ICL sizing and achieve a higher percentage of eyes with the desired vault.

Three-year follow-up of posterior chamber phakic intraocular lens with a central port design after deep anterior lamellar keratoplasty

Background

To evaluate clinical outcomes of the Visian implantable collamer lens (ICL) with a central port to correct myopia and astigmatism after deep anterior lamellar keratoplasty (DALK) for keratoconus throughout 3 years of follow-up.

Methods

This study included 20 eyes of 20 patients that underwent V4c ICL (13 eyes with a spherical ICL and 7 eyes with a toric ICL) implantation after DALK. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), and vault were analyzed.

Results

The mean UDVA improved from the preoperative 1.18 ± 0.33 logMAR to 0.25 ± 0.14 logMAR at 6 months after surgery (P < 0.0001) and remained unchanged throughout the whole follow-up (P = 0.4). All eyes gained lines of CDVA compared to preoperative values. At the last follow-up visit, all eyes achieved CDVA of 0.2 logMAR or better and 13 eyes (65%) 0.1 logMAR or better. At 6 months post-surgery, all eyes (100%) had a spherical equivalent within ± 1.50 D, and 19 (95%) within ± 1.00 D. The mean manifest spherical equivalent was stable over the postoperative follow-up (P = 0.25). No significant increase in IOP occurred in any case throughout the 3 years of follow-up. The loss in ECD from the preoperative baseline at the last follow-up visit was 2.27%.

Conclusions

The clinical outcomes suggest that the V4c ICL implantation for correction of myopia and regular astigmatism in post-DALK eyes was satisfactory in terms of effectiveness, safety, and stability during 3 years of follow-up.

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.

Accuracy of Intraocular Lens Calculation Formulas in Patients Undergoing Combined Phakic Intraocular Lens Removal and Cataract Surgery

PURPOSE

To investigate the prediction accuracy of intraocular lens (IOL) calculation formulas, and the impact of anterior chamber depth (ACD) and lens thickness (LT) measurement errors on IOL power calculation in patients undergoing combined phakic IOL (PIOL) removal and cataract surgery.

DESIGN

Retrospective, consecutive case series study.

METHODS

Thirty-six PIOL implanted eyes (12 anterior chamber PIOLs and 24 posterior chamber PIOLs [PC-PIOL]) undergoing cataract surgery were included. The prediction accuracy of new formulas (Barrett universal II, Emmetropia verifying optical, Kane, and Ladas super formula) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) with or without Wang-Koch (WK) axial length (AL) adjustment was evaluated. The influence of ACD and LT measurement errors of IOLMaster 700 on refractive outcomes was also investigated.

RESULTS

The Kane and traditional formulas with WK AL adjustment had no significant systematic prediction error and displayed a smaller median absolute error, whereas the other formulas showed significant hyperopia shift (P < .05) and relatively lower prediction accuracy. The accuracy rate of IOLMaster 700 in measuring the ACD and LT was 100% in eyes with anterior chamber PIOL implantation, and 37.50% in the PC-PIOL subgroup. No significant difference was observed in refractive outcomes of formulas using correct and wrong parameters in the PC-PIOL subgroup (P > .05).

CONCLUSIONS

The Kane and traditional formulas with WK AL adjustment exhibited relatively higher prediction accuracy in patients who underwent combined PIOL removal and cataract surgery. The IOLMaster 700 displayed low accuracy in ACD and LT measurements for PC-PIOL implanted eyes, but showed negligible impact on IOL prediction accuracy.

Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens

Aim and objective

We report the first case of bilateral cataract formation and pupillary block glaucoma and high intraocular pressure (IOP) following implantable Collamer lens (ICL) implantation that resulted in advanced visual field loss.

Background

The patient who underwent bilateral ICL implantation can develop bilaterally elevated IOP and an anterior subcapsular cataract with altitudinal visual field defect.

Case description

A 38-year-old man with high myopia presented for routine follow-up status post bilateral phakic ICL placement. The visual acuity was reduced due to an anterior subcapsular cataract and elevated IOP in both eyes with advanced glaucomatous visual field defects. The patient was treated with topical glaucoma medications. The left eye underwent same-day phakic ICL explanation and cataract surgery to prevent further visual field loss.

Conclusion

Cataract and glaucoma are serious complications after phakic ICL implantation; therefore, regular postoperative monitoring may prevent advanced visual impairment.

Clinical significance

The use of a phakic intraocular lens for the correction of myopia may result in complications. As a measure is to reduce such complications, refractive surgeons preferred using phakic posterior chamber intraocular Collamer lens for the correction of myopia.

How to cite this article

Owaidhah O, Al-Ghadeer H. Bilateral Cataract Development and Pupillary Block Glaucoma Following Implantable Collamer Lens. J Curr Glaucoma Pract 2021;15(2):91–95.

Prediction of the trabecular iris angle after posterior chamber phakic intraocular lens implantation

PURPOSE

To create an equation for predicting the trabecular iris angle (TIA) and to verify its accuracy after implantable collamer lens (ICL) implantation.

SETTING

Nagoya Eye Clinic, Nagoya, Japan.

DESIGN

Retrospective evaluation of a screening approach.

METHODS

The subjects included 174 eyes (174 patients) that underwent ICL implantation. Patients were randomly assigned to the prediction equation group (116 eyes) or verification group (58 eyes). Anterior segment optical coherence tomography (AS-OCT; CASIA2 TOMEY) was performed before and 3 months after ICL surgery. For the prediction group, a prediction equation was created with the preoperative AS-OCT parameters and ICL size as independent variables and the postoperative anterior chamber depth (ACD) as dependent variables. Then, by applying the predicted post-ACD and preoperative AS-OCT parameters as independent variables and TIA after ICL surgery as the dependent variable, a prediction equation was created to predict the postoperative TIA (post-TIA) after ICL surgery. Each prediction equation was created using stepwise multiple regression analysis, and its accuracy was verified by a Bland-Altman plot in the verification group.

RESULTS

The explanatory variables (standardized partial regression coefficient) selected in the post-TIA prediction equation were post-ACD (0.629), TIA750 (0.563), iris curvature (0.353), pupil diameter (-0.281), iris area (-0.249), and trabecular iris space area 250 (-0.171) (R2 = 0.646). There were no clinically significant systematic errors between measured and predictive post-TIA values in the verification group. The average absolute prediction error was 3.43° ± 2.22°.

CONCLUSIONS

Post-TIA can be accurately predicted from the predicted post-ACD and other preoperative AS-OCT parameters.

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose: To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients.Methods: This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up.Results: Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy.Conclusions: ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

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

PURPOSE

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

SETTING

Clinica Baviera, Madrid, Spain.

DESIGN

Retrospective cross-sectional single-center study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Seven-year follow-up of posterior chamber phakic intraocular lens with central port design

BACKGROUND

To assess the clinical outcomes of the Visian Implantable Collamer Lens (ICL) with a central port throughout 7 years of follow-up.

METHODS

Eighty-four eyes of 52 patients were evaluated over a follow-up period of 7 years after V4c ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD) and vault were analysed.

RESULTS

The mean postoperative UDVA (logMAR) was 0.04 ± 0.11, 0.13 ± 0.19 and 0.17 ± 0.23 at 1-, 5- and 7-years, respectively (P < 0.0001). The mean CDVA (logMAR) remains unchanged throughout a 7-year follow-up period (0.02 ± 0.08 and 0.02 ± 0.08, at 5- and 7-years, respectively, P = 0.2). At all follow-up visits, more than 95% of the eyes achieved a CDVA of 20/25 or better and more than 85% a CDVA of 20/20. At the end of the follow-up (7 years), no eye lost more lines of CDVA, 56 eyes (66.7%) and 28 eyes (33.3%) gained lines of CDVA. At 7-years, the spherical equivalent was - 0.62 ± 0.62 D. No significant increase in IOP (> 20 mmHg or an increase higher than 5 mmHg) occurred in any case throughout the 7-year of follow-up. The loss in ECD from the preoperative baseline at the last follow-up visit was 2.6%. No intraoperative or postoperative complications or adverse events occurred during the follow-up period.

CONCLUSIONS

The outcomes of this study show the long-term viability of the V4c ICL implantation as a surgical option for the correction of myopia.

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

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

Visual acuity, refractive error, and regression outcomes in 169 children with high myopia who were implanted with Ophtec-Artisan or Visian phakic IOLs

PURPOSE

To analyze outcomes in a large cohort of spectacle-aversive children with high myopia who were treated by implantation of the Ophtec-Artisan or Visian phakic intraocular lens (pIOL).

METHODS

Outcome data were collated retrospectively in 78 children (115 eyes) implanted with the Ophtec-Artisan iris-enclaved anterior chamber pIOL and 91 children (154 eyes) implanted with the Visian ICL (intraocular collamer lens) sulcus pIOL. All children had difficulties with spectacle or contact lens wear. Mean age at surgery was 9.9 years; mean follow-up was 3.9 years (range, 0.6-14.1 years).

RESULTS

A total of 248 of 269 eyes (92%) were corrected to within ± 0.5 D of their target value. Spherical correction averaged 12.3 ± 1.0 D. Refractive spherical regression was -0.04 D/year at last follow-up. Uncorrected distance visual acuity improved from an average logMAR 1.8 to 0.4; corrected distance visual acuity improved an average 0.3 logMAR. Of the treated children, 68% had a gain in binocular fusion. Neurobehavioral and/or visuomotor comorbidities were present in 87% of children. Five eyes (2%) developed retinal detachment an average 6 years after implantation. Nine eyes (3%) implanted with the Ophtec-Artisan pIOL required repositioning after trauma.

CONCLUSIONS

Implantation of pIOLs in children is an effective method for correcting high myopia in spectacle noncompliant children. Rates of myopic regression after pIOL surgery are substantially lower than those reported for children treated by excimer laser photorefractive keratectomy (PRK). The prevalence of major complications was relatively low in this high-risk population.

Assessment of low-vault cases with an implantable collamer lens

This study aimed to examine clinical results in low-vault eyes after implementation of a Hole implantable collamer lens (KS-AquaPORT™, STAAR Surgical Company) in terms of visual outcomes and complications over a one-year follow-up period. This was a retrospective cohort study of subjects who underwent Hole implantable collamer lens surgery at Sanno Hospital, exhibited low vault, and were followed up for 1 year. Patients were included if they met the following criteria: 20≤ age ≤55 years; stable refraction ≥6 months; -1.0 to -20.0 diopters of myopia; endothelial cell density ≥1800 cells/mm²; and no history of ocular surgery, progressive corneal degeneration, cataract, glaucoma, or uveitis. Main outcome measurements were the safety and efficacy indices, predictability, and vault. Values were indicated as the mean ± standard deviation. Subjects included 16 patients (age: 38 ± 8 years; 6 males; 25 eyes). Toric lenses were utilized for 10 eyes. Implantable collamer lens size was 12.1, 12.6, and 13.2 mm for 18, 6, and 1 eye(s), respectively. One year postoperatively, the safety index was 1.07; for 22 eyes with a target refraction of that of emmetropic eyes, the efficacy index was 0.90; and 96% of eyes were within ± 0.50 diopters of attempted versus achieved spherical equivalent correction. Postoperative vault was 142 ± 60 μm. One year postoperatively, no additional surgery was required for rotation of toric implantable collamer lens, and no advanced cataracts, increased intraocular pressure, or decreased endothelial cells were observed. In conclusion, Hole implantable collamer lens yielded satisfactory visual outcomes and no postoperative complications for low-vault eyes, suggesting its suitability for such cases.

Comparison of Toric Implantable Collamer Lens and Toric Artiflex Phakic IOLs in Terms of Visual Outcome: a Paired Contralateral Eye Study

PURPOSE

This study sought to compare the postoperative visual outcomes of toric implantable collamer lens (T-ICL) with toric Artiflex (T-Artiflex) lenses.

DESIGN

Alternating treatment, contralateral eye matched clinical study.

METHODS

This study compared 82 eyes of 41 patients with T-ICL lenses in one eye and toric Artiflex implantation in the contralateral eye to correct myopic astigmatism. Safety, efficacy, predictability, astigmatic vector changes, contrast sensitivity, endothelial cell count, and possible adverse events were assessed at least 12 months postoperatively.

RESULTS

After a mean follow-up of 12 months, the safety index was mean 1.40 ± 0.70 in the T-ICL group and 1.20 ± 0.21 in the T-Artiflex group. Furthermore, their mean efficacy indexes were 1.24 ± 0.42 and 1.08 ± 0.23, respectively (P = .029). A total of 39 eyes (95%) in the T-ICL group and 41 eyes (100%) in the T-Artiflex group were within ±1.00 diopter (D) of emmetropia and 33 eyes (80%) and 34 eyes (83%) were within ±0.5 D of emmetropia, respectively. Vector analysis revealed mean index of success as large as 0.25 ± 0.22 in the T-ICL group and 0.24 ± 0.15 in the T-Artiflex group. Postoperative contrast sensitivities were equal in both groups under mesopic conditions for any given spatial frequency. There was an endothelial loss of 2.18% and 1.95% in the T-ICL and T-Artiflex groups, respectively. There were no significant complications in any of the groups.

CONCLUSIONS

Both lenses showed promising results in terms of safety, efficacy, and predictability for correction of myopic astigmatism. As shown in this paired-eye study, most outcomes were almost identical, and neither of these lenses were clinically superior to the other.

Femtosecond laser assisted cataract surgery in a cataract patient with a "0 vaulted" ICL: a case report

BACKGROUND

Femtosecond laser assisted cataract surgery (FLACS) combined with implantable collamer lenses (ICLs) extraction has been shown to be a feasible method for patients developing cataracts after the ICL implantation. All reported cases had shallow vaults, ranging from 47 μm (μm) to 100 μm. We report for the first time, a case in which the FLACS was performed on the "0" vault eye.

CASE PRESENTATION

A 38-year-old man with anterior subcapsular cataracts underwent the FLACS combined with ICLs extraction 6 years after ICLs implantation in both eyes. In his left eye, the ICL touched the anterior capsule, existing "0" vault. During the capsulotomy, cavitation bubbles were trapped in the shallow space beneath the ICL, developing from small bubbles into big ones, which resulted in the incomplete capsulotomy. Comparatively, in the right eye, the ICL vault was measured 72 μm, and the capsulotomy was complete and no big cavitation bubbles formed. In both eyes, capsulotomy zones were manually assigned to the anterior capsule surface in the process of laser identification. However, the nuclear pre-fragmentations were unsuccessful in both eyes. Other steps of surgeries were performed uneventfully. Depending on the design of monovision, the uncorrected distance visual acuity (UDVA) was 20/32, and the near uncorrected visual acuity (UCVA) was 20/25 in both eyes postoperatively.

CONCLUSIONS

This case suggested that the surgeon should pay attention to the incomplete laser capsulotomy when using a femtosecond laser in cataractous cases with "0" vaulted ICLs, and manual adjustment was required in the process of laser identification.

Posterior Chamber Phakic Intraocular Lens Implantation for the Correction of Myopia and Myopic Astigmatism: A Retrospective 10-Year Follow-up Study

PURPOSE

To assess the 10-year clinical outcomes of implantable collamer lens (ICL) implantation for myopia and astigmatism.

DESIGN

Retrospective observational case series.

METHODS

This study included 114 eyes of 61 patients who underwent ICL implantation for correction of myopia and myopic astigmatism. We assessed the safety, efficacy, predictability, stability, and adverse events preoperatively, at 6 months (106 eyes) and 1 (94 eyes), 3 (58 eyes), 5 (65 eyes), 8 (89 eyes), and 10 (70 eyes) years postoperatively. Only the eyes with clinical data available at each follow-up time were analyzed.

RESULTS

The mean logMAR uncorrected and corrected distance visual acuities were -0.01 ± 0.24 and -0.18 ± 0.07 at 10 years postsurgery. The mean indices for safety and efficacy were 0.88 ± 0.15 and 0.66 ± 0.26, respectively. At 10 years postsurgery, 71.4% and 87.1% of the eyes were within 0.5 and 1.0 diopters (D), respectively, of the attempted spherical equivalent correction. The mean intraocular pressure was 13.1 ± 2.4 mmHg preoperatively and 13.1 ± 2.9 mmHg at 10 years postoperatively. The mean endothelial cell loss was 5.3% at 10 years postsurgery. Twelve of 114 eyes (10.5%) developed anterior subcapsular cataract during 5-10 years' follow-up; among these, 4 eyes (3.5%) were symptomatic and ICL explantation and phacoemulsification surgery were performed. No vision-threatening complications occurred during the observation period.

CONCLUSION

ICL implantation offered good overall outcomes in all measures of safety, efficacy, predictability, and stability for the correction of myopia and myopic astigmatism throughout a long-term follow-up period of 10 years.

Comparative analysis of clinical outcomes between two types of posterior chamber phakic intraocular lenses for correction of myopia and myopic astigmatism

Purpose:

To compare clinical outcomes following implantation of two types of posterior chamber phakic intraocular lenses: Visian™ Implantable Collamer Lens with Centraflow (ICL, V4C Staar Surgical, Nidau, Switzerland) and Implantable Phakic Contact Lens (IPCL, V1, Caregroup Sight Solution, India) for the correction of myopia and myopic astigmatism.

Methods:

This retrospective case series included eyes which underwent phakic intraocular lens implantation with a minimum follow-up period of 1 year. Visual outcomes including safety, efficacy, refractive predictability, and stability were compared at 1 week and at 1, 6, and 12 months’ postoperative visit. Complications and adverse events were analyzed.

Results:

The study included 119 and 203 eyes in the IPCL and ICL groups, respectively. At 1-year postoperative visit, median corrected distance visual acuity was 0.10 (interquartile range [IQR] 0,0.10) and 0 (IQR 0,0) in the IPCL and ICL cohorts, respectively (P = 0.066). An uncorrected visual acuity of 20/32 or better was achieved in 86.5% and 88.67% of the eyes, respectively (P = 0.574). Ninety and 94% of the eyes achieved a postoperative manifest spherical equivalent within ± 0.5D (P = 0.169, χ² test). Three eyes (2.52%) in the IPCL group versus one eye (0.49%) in the ICL group developed visually significant cataract requiring surgical intervention (P = 0.113). No vision-threatening complications were noted in either cohort. The mean follow-up period was 94.69 ± 32.45 and 102.67 ± 61.82 weeks, respectively.

Conclusion:

Both groups demonstrated similar efficacy and safety profile. The IPCL is an effective and economically viable option for the correction of myopia.

Influence of refractive error on pupil diameters in highly myopic eyes with implantable collamer lenses

PURPOSE

To investigate the influence of refractive error on pupil diameters in highly myopic eyes with implantable collamer lenses.

SETTING

Shanghai, China.

DESIGN

A prospective consecutive observational study.

METHODS

Sixty-six eyes of 66 patients that underwent ICL V4c implantation were included. Pupil diameters before and 1 week, 1 month, and 3 months after surgery were measured using an automatic pupillometry system (MonCv3; Metrovision, Pérenchies, France) under four standardized illumination conditions: 0, 1, 10, and 100 cd/m². The correlations between changes in pupil diameter and spherical equivalent values and patient age were investigated.

RESULTS

Based on preoperative spherical equivalent values, included eyes were divided into a high-myopia group (-6.3 to -9.9 D (diopters)) and a super-high-myopia group (-10 to -20 D). Pupil sizes remained unchanged after surgery in the high-myopia group and decreased at 1 and 10 cd/m² in the super-high-myopia group. A between-group comparison showed that pupils were significantly smaller in the super-high-myopia group 1 week postoperatively under all illumination conditions and remained smaller at 1 month and 3 months under 1 and 10 cd/m² lighting conditions. Preoperative spherical equivalent values were significantly correlated with the percent decrease in pupil diameter 1 week postoperatively under 0, 1, and 10 cd/m² illumination conditions; the greater the degree of myopia, the greater the reduction in pupil diameter.

CONCLUSION

Preoperative refractive error significantly affects pupil diameter in highly myopic eyes after implantable collamer lens implantation. Pupils of super highly myopic eyes remained smaller than preoperative levels under mesopic conditions after implantable collamer lens implantation.

Predictability of the vault after posterior chamber phakic intraocular lens implantation using anterior segment optical coherence tomography

PURPOSE

To determine whether vault measurements after placement of a hole implantable collamer lens (hole ICL) (KS-AquaPORT) can be predicted by angle-to-angle (ATA) and white-to-white (WTW) measurements obtained with anterior segment optical coherence tomography (AS-OCT).

SETTING

Sanno Hospital, Tokyo, Japan.

DESIGN

Retrospective case series.

METHODS

Eyes were observed for 3 months after hole ICL implantation for myopia or myopic astigmatism. Central vault, ATA, and WTW measurements were obtained before and after surgery using the swept-source AS-OCT CASIA2 system.

RESULTS

The study included 44 eyes (23 patients). The mean patient age and preoperative spherical equivalent, ATA, and WTW values were 36.2 years ± 8.8 (SD), -6.23 ± 3.41 diopters (D), 12.03 ± 0.40 mm, and 11.72 ± 0.40 mm, respectively. The safety index and efficacy index 3 months postoperatively were 1.13 ± 0.21 and 0.91 ± 0.30, respectively. Regarding predictability, 93.2% of eyes were within ±0.50 D of the attempted correction and all eyes were within ±1.00 D. The reproducibility coefficients for the ATA distance and WTW distance were 0.998 and 0.960, respectively. The mean postoperative central vault was 491.6 ± 189.5 μm. There was a significant correlation between postoperative vault and the ICL size and ATA distance (Spearman rank correlation coefficient r = 0.59, P < .001) but not between the ICL size and WTW distance (r = 0.27, P = .08).

CONCLUSION

The ATA measurements had higher reproducibility than the WTW measurements on AS-OCT, making it is a more important predictor of postoperative vault.

The effect of mydriasis on moderate-to-high myopic eyes with implantable collamer lenses V4 and V4c

PURPOSE

To evaluate the vault change and anterior segment movement induced by mydriasis in moderate-to-high myopic eyes with implantable collamer lenses (ICL).

SETTING

Shanghai, China.

DESIGN

A prospective consecutive observational study.

METHODS

A total of 45 eyes of 24 patients with ICL V4 implantation and 128 eyes of 65 patients with ICL V4c implantation were included and analyzed. Anterior chamber depth, posterior corneal endothelium-to-ICL distance, and vault before and after mydriasis were measured by Pentacam (Oculus, Wetzlar, Germany) at 1, 3, and 6 months after surgery.

RESULTS

Significant vault increases and anterior chamber depth increases induced by mydriasis were noted in both ICL V4 and V4c groups at 1, 3, and 6 months postoperatively. The corneal endothelium-ICL distance increased significantly in eyes with implanted ICL V4c after mydriasis at 3 and 6 months. Moreover, mydriasis-induced vault increases were greater in the ICL V4 group than in the ICL V4c group at 3 and 6 months. In eyes with implanted ICL V4c, mydriasis-induced vault increases were significantly greater at 1 month than at 3 and 6 months.

CONCLUSION

Mydriasis results in a general vault increase in eyes with implanted ICLs. The adjustment of the pressure equilibrium via the central hole of the ICL V4c has an important role in vault change. The mydriasis-induced vault increases tend toward stability after 3 months postoperatively. Mydriasis is relatively safe in eyes with ICL implantation.

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM

To compare Visian lens (model V4c) and Artiflex lens regarding quality (contrast sensitivity) and quantity (efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications.

METHODS

The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation (model V4c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia (higher than 6.0 D) and stable refraction (<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1d, 1wk and 1, 3, 6 and 12mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria.

RESULTS

After 12mo of follow up, difference in uncorrected and corrected distant visual acuity (CDVA) between both groups was statistically insignificant (UDVA for VisianV4c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses (safety index was 1.67 for VisianV4c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant (P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies).

CONCLUSION

Both Visian ICL V4c and Artiflex lenses are safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.

Safety and Efficacy of a New Phakic Posterior Chamber IOL for Correction of Myopia: 3 Years of Follow-up

PURPOSE

To evaluate the outcomes of a new posterior chamber phakic intraocular lens (IPCL; Care Group, Baroda, India) to correct myopia.

METHODS

This prospective, observational case series included 30 eyes undergoing implantation of the IPCL for high myopia (> -8.00 diopters [D]). Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, vault, endothelial cell loss, and adverse events were evaluated 3 years after implantation of the IPCL for high myopia.

RESULTS

The mean spherical equivalent decreased from -16.50 ± 5.62 D preoperatively to -0.89 ± 1.27 D at 3 years. The mean UDVA and CDVA were 0.38 ± 0.21 and 0.24 ± 0.09 logMAR. No eye lost any lines and 49% of eyes gained one line or more of CDVA. One eye (3.3%) developed anterior subcapsular cataract, but did not require cataract surgery at 3 years of follow-up. Two eyes (6.6%) developed a mild transient increase in intraocular pressure, which required topical medication only for 3 months. The percentage of endothelial cell loss at 3 years was 9.73% ± 6.72%. The IPCL vault tended to reduce with time, from a mean of 626.66 ± 188.98 μm at 1 month to 540.22 ± 210.76 μm at 3 years. No vision-threatening complications occurred.

CONCLUSIONS

Implantation of the new posterior chamber phakic IOL is an effective alternative to correct high myopia, showing good outcomes at 3 years. [J Refract Surg. 2018;34(12):817-823.].

Long-term safety of posterior chamber implantable phakic contact lens for the correction of myopia

Purpose

To review the safety of the implantable phakic contact lens (IPCL V1, Caregroup Sight Solutions, India) for correction of myopia and myopic astigmatism.

Methods

Retrospective interventional case series including 134 eyes which underwent IPCL implantation for correction of myopia and myopic astigmatism at a tertiary eye care hospital in South India. Intraoperative and postoperative complications were analyzed. The following parameters were analyzed at preoperative and 1, 6 and 12 month postoperative visits: visual acuity (in logMAR) and manifest refraction, slit lamp bio microscopy, dilated fundus examination, IOP and endothelial cell density measurement.

Results

No intraoperative complications were noted. Cataract was the most common postoperative complication, wherein three eyes (2.2%) underwent observation for visually insignificant anterior subcapsular cataract and one eye (0.7%) required surgical intervention. Four eyes developed transient increased IOP due to steroid response (3 eyes) and pupillary block glaucoma (1 eye). The endothelial cell loss noted over a 1-year follow-up was 2.01%±4.12% (P=0.71). One eye developed hypopyon on the third postoperative day, which resolved subsequently with an unaided vision of 20/20. No vision threatening complications were noted. The mean follow-up in the cohort was 25.66±16.45 months.

Conclusion

The IPCL is a safe and effective treatment modality for correction of myopia and myopic astigmatism.

Implantable collamer lens with central hole: 3-year follow-up

Purpose

To evaluate the long-term predictability, stability, safety, and efficacy of the V4c Visian implantable collamer lens (ICL) with central hole to correct myopia.

Patients and methods

One hundred and eighty-four eyes of 92 patients were evaluated during 3 years after implantation of the V4c ICL. The refraction, uncorrected distance visual acuity, best-corrected distance visual acuity, IOP, endothelial cell count, vault, and adverse effects were evaluated every 12 months during the whole follow-up.

Results

The mean spherical equivalent dropped from -8.30±2.98 D preoperatively to −0.37±0.47 D at 36 months post-surgery, with 91.8% eyes being within ±1.00 D of emmetropia. With respect to the astigmatic components J0 and J45, 98.4% and 99.5% of eyes, respectively, were within ±0.50 D of the desired refraction. At 36 months, 78.8% of eyes had no change in the Snellen lines of best-corrected distance visual acuity, while 8.7% gained one line and 6.5% gained two or more lines; mean safety and efficacy indexes were 1.03 and 0.90, respectively. Mean endothelial cell count was 2,742±340 cells/mm² before and 2,663±366 cells/mm² at 36 months post-surgery. Mean IOP reduced from 13.7±1.9 mmHg preoperatively to 12.8±1.7 mmHg at 36 months post-surgery. Mean vault varied from 409±196 µm at 12 months to 349±165 µm at 36 months.

Conclusion

The visual and refractive outcomes were very good and highly stable throughout the follow-up period, indicating that this ICL model may be predictable, stable, safe, and effective to correct myopia in the long term.

Computational simulation of aqueous humour dynamics in the presence of a posterior-chamber versus iris-fixed phakic intraocular lens

Purpose

To compare aqueous humour (AH) dynamics in the presence of a precrystalline (Implantable Collamer Lens^®; ICL) or iris-fixed (Artiflex^®) phakic intraocular lens (PIOL).

Methods

By computational fluid dynamics simulation, AH flow was modelled through a peripheral iridotomy (PI) or central lens hole (both 360 μm) in the presence of an Artiflex or ICL lens, respectively. The impacts of AH flow were then determined in terms of wall shear stress (WSS) produced on the endothelium or crystalline lens. Effects were also modelled for different scenarios of pupil diameter (PD 3.5 or 5.5 mm), ICL vault (100, 350, 800 μm) and number of Artiflex iridotomies (1 or 2) and location (12 or 6 o’clock).

Results

For a PD of 3.5 mm, AH volumes flowing from the posterior to the anterior chamber were 37.6% of total flow through the lens hole (ICL) and 84.2% through PI (Artiflex). For an enlarged PD (5.5 mm), corresponding values were 10.3% and 81.9% respectively, so PI constitutes a very efficient way of evacuating AH. Central endothelial WSS in Pa was lower for the large vault ICL and the Artiflex (1⁻⁰³ and 1.1⁻⁰³ respectively) compared to the PIOL-free eye (1.6⁻⁰³). Crystalline lens WSS was highest for the lowest vault ICL (1⁻⁰⁴).

Conclusions

AH flow varied according to the presence of a precrystalline or iris-fixed intraocular lens. Endothelial WSS was lower for an implanted ICL with large vault and Artiflex than in the PIOL-free eye, while highest crystalline WSS was recorded for the lowest vault ICL.

Analysis of pre-operative factors affecting range of optimal vaulting after implantation of 12.6-mm V4c implantable collamer lens in myopic eyes

Background

To evaluate clinical factors affecting postoperative vaulting in eyes that had achieved optimal vaulting within the range of 250–750 μm following implantation of 12.6-mm V4c implantable collamer lenses (ICL).

Methods

A total of 236 eyes of 236 patients that had achieved optimal vaulting following implantation of a 12.6-mm V4c ICL were retrospectively analyzed. Associations between postoperative vaulting and age, preoperative anterior chamber depth (ACD), preoperative axial length (AL), preoperative white-to-white diameter, preoperative pupil size, preoperative sulcus-to-sulcus diameter, and preoperative manifest refraction spherical equivalent were investigated using simple regression, stepwise multiple regression, and multinomial logistic regression analyses.

Results

Mean central vaulting at the 6-month follow-up was 519.0 ± 112.8 μm. Variables relevant to postoperative vaulting were, in order of influence, preoperative ACD (β = 0.305, p <  0.001), preoperative pupil size (β = 0.218, p <  0.001), and preoperative AL (β = 0.171, p = 0.006). Low preoperative pupil size was associated with low optimal vaulting (250 to 450 μm), relative to that observed in the mid optimal vaulting group (451 to 550 μm) (odds ratio = 0.532, P = 0.021). Increasing preoperative ACD was associated with high optimal vaulting (551 and 750 μm), relative to that observed the mid optimal vaulting group (odds ratio = 6.340, P = 0.034).

Conclusions

Myopic eyes with greater preoperative ACD, larger pupil size, and longer AL are predisposed to higher postoperative vaulting following 12.6-mm V4c ICL implantation. Therefore, the extremes of these parameters should be considered when choosing V4c ICL size.

Two-Year Outcomes of Visian Implantable Collamer Lens with a Central Hole for Correcting High Myopia

Purpose

To investigate two-year outcomes of Visian Implantable Collamer Lens with a central hole (ICL V4c) implantation for correcting high myopia.

Methods

Sixty-one eyes of 32 patients went through ICL V4c implantation. Safety, efficacy, predictability, and intraocular pressure were evaluated 2 years postoperatively. Anterior chamber volume (ACV), anterior chamber depth (ACD), anterior chamber angle width (ACAW), and vault were measured using a Scheimpflug tomography imaging system.

Results

At 2 years, the spherical equivalent refraction decreased from preoperative −14.62 ± 4.29 D to −0.90 ± 0.95 D, with 79% of the eyes within ±0.50 D and 98% within ±1.00 D of the intended correction. The efficacy index was 1.03 ± 0.23, and the safety index was 1.24 ± 0.26. Corrected distance visual acuity (CDVA) remained unchanged in 23% of the eyes, 75% gained one or more lines of CDVA, and 2% lost one line. The ACV, ACD, and ACAW, respectively, decreased from 193.28 ± 29.15 mm³, 3.15 ± 0.23 mm, and 36.51 ± 6.54 degree to 112.48 ± 17.01 mm³, 2.99 ± 0.23 mm, and 22.54 ± 5.27 degree (p=0.0008, 0.008, and  0.0003, resp.). Intraocular pressure was 15.39 ± 2.88 mmHg before surgery and was 15.86 ± 4.11 mmHg at 2 years (p=0.11).

Conclusion

Implantation of ICL V4c is a safe, effective, and predictable procedure for correcting high myopia. Reduction of anterior chamber space after surgery did not induce intraocular pressure increase during the 2-year follow-up.

Refractive outcomes and optical quality after implantation of posterior chamber phakic implantable collamer lens with a central hole (ICL V4c)

Background

To investigate refractive outcomes and optical quality after implantation of posterior chamber phakic implantable collamer lens with a central hole (ICL V4c) to correct high myopia.

Methods

Sixty seven eyes of 38 patients who underwent ICL V4c implantation were enrolled. The mean preoperative spherical equivalent (SE) was − 12.44 ± 3.15 D (range: − 6.63 to − 20.50 D). The refractive outcomes and optical quality of the eyes at postoperative 1 and 3 months were evaluated and compared.

Results

At 3 months postoperatively, the mean safety and efficacy indexes were 1.33 ± 0.22 and 1.14 ± 0.23, respectively. The mean SE was − 0.32 ± 0.52 D; no patient lost 1 or more lines of corrected distance visual acuity (CDVA), 13% remained unchanged, 45% gained 1 line and 42% gained 2 or more lines. The mean modulation transfer function cutoff frequency (MTF_cutoff), Strehl in two dimensions ratio, and objective scatter index (OSI) were 38.20 ± 9.96 cycles per degree, 0.21 ± 0.06, and 1.00 ± 0.73, respectively. No significant difference was found in any of the above parameters (P > 0.05) between 1 and 3 months. The postoperative intraocular pressure (IOP) did not change when compared with preoperative values (P > 0.05).

Conclusions

ICL V4c implantation is a safe, effective, and stable solution for high myopia. Patients will acquire high and stable postoperative optical quality. ICL V4c implantation has little influence on IOP.

Intraoperative Optical Coherence Tomography Vault Measurement in Posterior Chamber Phakic Intraocular Lens Implantation

PURPOSE

To describe the use of intraoperative optical coherence tomography (OCT) vault measurement in 5 cases of posterior chamber phakic intraocular lens (IOL) implantation.

METHODS

This case series included 5 eyes in 3 consecutive patients undergoing phakic IOL implantation. RTVue OCT (Optovue, Inc., Fremont, CA) was used to obtain intraoperative vault measurements after pupil constriction. Visante OCT (Carl Zeiss Meditec, Jena, Germany) was used to obtain postoperative vault measurements.

RESULTS

Intraoperative vault measurements ranged from 228 to 1,060 µm. There were no postoperative complications. Postoperative OCT vault measurements ranged from 230 to 670 µm.

CONCLUSIONS

Intraoperative OCT can be a useful tool in phakic IOL implantation to provide real-time intraoperative vault measurements. This may help to confirm appropriate phakic IOL sizing and guide decision-making at the time of surgery. [J Refract Surg. 2017;33(4):274-277.].

Pupil Dynamics Induced by Light Reflex After Posterior Chamber Phakic Intraocular Lens Implantation

PURPOSE

To assess the light reflex of the pupil after Implantable Collamer Lens (ICL) (KS-aquaPORT; STAAR Surgical, Nidau, Switzerland) implantation to determine whether the ICL implantation might affect the pupil dynamics.

METHODS

This study examined 28 eyes of 28 consecutive patients who underwent implantation of the posterior phakic ICL for the correction of myopia and astigmatism. Patient age at the time of surgery was 31.1 ± 6.8 years (range: 25 to 42 years). Preoperative refraction was -7.38 ± 2.26 diopters (D) (range: -3.25 to -11.80 D). Light reflex was evaluated using the infrared pupillometer Iriscorder C7364 (Hamamatsu Photonics, Hamamatsu, Japan). Measured parameters included pupil diameter (D1), constriction ratio, maximum constriction velocity, maximum dilation velocity, and the time required to recover 63% of the pupil diameter (T5). At 6 months postoperatively, the authors also investigated the relationship with the amount of vault using the Pentacam (Oculus Optikgeräte, Wetzlar, Germany). Evaluations with the instrument were performed before and at 1, 3, and 6 months after surgery.

RESULTS

There was no significant association found between any of the parameters (analysis of variance, D1: P = .99, constriction ratio: P = .59, maximum constriction velocity: P = .87, maximum dilation velocity: P = .13, T5: P =.57). The vault of the ICL at 6 months postoperatively was 382.1 ± 176.5 μm. There were no significant associations between the maximum constriction velocity, maximum dilation velocity, and amount of vaulting (Spearman correlation coefficient maximum constriction velocity: r = 0.07, P = .71, maximum dilation velocity: r = 0.26, P = .28).

CONCLUSIONS

The light reflex of the pupillary dynamics continued to be maintained at 6 months after ICL implantation. Current findings also verified that ICL implantation had little influence on the postoperative function of the iris. [J Refract Surg. 2017;33(10):704-707.].

Buffering zone of implantable Collamer lens sizing in V4c

Background

The purpose of this study was to identify factors related to the unexpected vault in V4c implantable collamer lens (ICL; STAAR Surgical) implantation.

Methods

V4c ICLs were implanted in 43 eyes of 43 patients for the correction of myopia. The implanted V4c ICL sizes were determined individually with our previous V4 ICL sizing nomogram based on the sulcus-to-sulcus diameter (STS), and the V4 ICL sizes were then converted to V4c ICL sizes with a size-converting table. We defined the “normal-sizing group” as having a pre-converted ICL size larger than the STS, and the “under-sizing group” as having a pre-converted ICL size smaller than the STS. Refractive outcomes, safety and parameters related to postoperative vault were compared between the two groups.

Results

The value of “actual ICL size – STS” differed significantly between the normal-sizing and under-sizing groups (p < 0.001), but postoperative vault did not differ significantly (p = 0.442). The demographics, implanted ICL characteristics, effectiveness indexes, safety indexes, and parameters related to postoperative vault did not differ significantly between the two groups (p > 0.05). Two patients in the normal-sizing group exhibited over-vaulting; these patients had shallow anterior chambers and were implanted with high-dioptric-power ICLs.

Conclusions

The achievement of acceptable vault in both normal-sizing and under-sizing groups indicates the existence of a buffering zone in V4c ICL sizing. The smaller size of V4c ICLs should be considered in patients susceptible to over-vaulting, such as those with shallow anterior chambers and high-dioptric-power ICLs.

Impacts of Implantable Collamer Lens V4c Placement on Angle Measurements Made by Optical Coherence Tomography: Two-Year Follow-up

PURPOSE

To determine iridocorneal angle changes produced after 2 years of implantable collamer lens (ICL) V4c (STAAR Surgical AG, Nidau, Switzerland) placement by Fourier-domain optical coherence tomography (FD-OCT).

DESIGN

Prospective interventional case series.

METHODS

In 54 eyes of 27 myopic subjects FD-OCT iridocorneal angle measurements were made before and 1 month, 3 months, 1 year, and 2 years after ICL implant. Trabecular-iris angle (TIA), angle opening distance 500 μm from the scleral spur (AOD₅₀₀), and iridotrabecular contact length (TICL) were compared among these time points and the nasal, temporal, and inferior quadrants.

RESULTS

Preoperative TIAs were 49.5 ± 8.7, 48.3 ± 9.6, and 49.1 ±8.6 degrees for the nasal, temporal and inferior quadrants (P < .001). Corresponding values were 29.9 ± 10.4, 28.4 ± 10.8, and 28.8 ± 9.7 degrees at 1 month and 27.3 ± 8.8, 26.8 ± 8.1, and 28.9 ± 7 degrees at 2 years of follow-up, indicating angle narrowing of 39%-45% and no further narrowing beyond 1 month in the nasal (P = .133), temporal (P = .376), and inferior (P = 1.000) quadrants. Trabecular-iris contact (TIC) was observed in 8 eyes of 8 subjects, mostly only in the temporal quadrant. Mean TICL failed to vary during follow-up (307 ± 288 μm at 3 months and 225 ± 142 μm at 2 years, P = .159).

CONCLUSIONS

In response to ICL V4c implant, considerable angle narrowing was detected at 1 month but this narrowing remained stable at 2 years. In the 8 cases of TIC, no progression of contact was observed beyond 3 months postimplant.

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism

BACKGROUND

To compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism.

METHODS

This study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years.

RESULTS

Preoperatively, the mean manifest spherical equivalent (SE) was -14.14 ± 2.12 D in the TICL group and -14.83 ± 2.79 D in the AK + ICL group (P = 0.28), and the mean manifest refractive cylinder, -2.87 ± 1.09 D and -2.58 ± 0.85 D, respectively (P = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group (P = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively (P = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group (P = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups.

CONCLUSIONS

Both TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.

TRIAL REGISTRATION

NCT03202485.

Four-year Follow-up of the Changes in Anterior Segment After Phakic Collamer Lens Implantation

PURPOSE

To assess the changes and relationship in central vaulting, flare intensity, and crystalline lens thickness during a follow-up period of 4 years after implantable collamer lens (ICL) implantation in eyes with high myopia.

DESIGN

Retrospective observational study.

METHODS

Ninety-eight eyes of 50 patients were followed up with routine measurements of central vaulting, crystalline lens thickness, endothelial cell density, and aqueous flare postoperatively. Data were analyzed by repeated-measures analysis of variance. The relationship between the annual change in crystal lens thickness after surgery and age was evaluated by Pearson correlation coefficient and linear regression.

RESULTS

There was a continuous reduction in central vaulting and endothelial cell density as well as an increase in crystalline lens thickness in ICL eyes from 1 month onward to 5 years postoperatively (P < .001). Although the trend of variation during the individual visit period was accentuated, the variation turned out to be smaller between 12 and 36 months or 60 months postoperatively (P = .42, P = .65). Aqueous flare intensity increased significantly after surgery and returned to normal 1 year later. Additionally, a positive correlation between patient age and crystalline lens thickness (r = 0.617, P < .0001) was observed in eyes with ICL implantation.

CONCLUSIONS

The changes in central vaulting, endothelial cell density, and crystalline lens thickness are more prominent during the first year after ICL implantation, tending to be relatively stable afterwards. The anterior inflammation during the early postoperative period synchronizes with the sharp progression of crystalline lens changes within the first year.

Phakic Intraocular Collamer Lens (Visian ICL) Implantation for Correction of Myopia in Spectacle-Aversive Special Needs Children

PURPOSE

A subset of children with high anisometropia or isoametropia and neurobehavioral disorders have chronic difficulties with spectacle or contact lens wear. We report the results of refractive surgery in a series of these children treated using bilateral or unilateral intraocular collamer lens (Visian ICL) implantation for moderate to high myopia.

DESIGN

Prospective nonrandomized cohort study.

METHODS

Clinical course and outcome data were collated prospectively for 40 implanted eyes in 23 children (mean age 10.2 ± 5.3 years, range, 1.8-17 years). Myopia ranged from -3.0 to -14.5 diopters (D), mean -9.2 ± 3.5 D. Goal refraction was plano to +1 D. Correction was achieved by sulcus implantation of a Visian ICL (STAAR Surgical, Monrovia, California, USA) under general anesthesia. Mean follow-up was 15.1 months (range, 6-22 months).

RESULTS

Thirty-five eyes (88%) were corrected to within ±1.0 D of goal refraction; the other 5 (12%) were corrected to within 1.5 D. Uncorrected distance visual acuity improved substantially in all eyes (from mean 20/1050 [logMAR 1.72] to mean 20/42 [logMAR 0.48]). Spherical regression at last follow-up was an average of +0.59 D. Visuomotor comorbidities (eg, amblyopia, nystagmus, foveopathy, optic neuropathy) accounted for residual postoperative subnormal visual acuity. Thirteen of the 23 children (57%) had a neurobehavioral disorder (eg, developmental delay/intellectual disability/mental retardation, Down syndrome, cerebral palsy, autism spectrum disorder). Eighty-five percent (11/13) of those children were reported to have enhanced visual awareness, attentiveness, or social interactions. Endothelial cell density was measureable in 6 cooperative children (10 eyes), showing an average 1% decline. Central corneal thickness, measured in all children, increased an average of 8 μm. Two children (8%) required unplanned return to the operating room on the first postoperative day to alleviate pupillary block caused by a nonpatent iridotomy. No other complications were encounterd.

CONCLUSION

Visian ICL implantation improves visual function in special needs children who have moderate to high myopia and difficulties wearing glasses or contact lenses.

Refractive outcomes and safety of the implantable collamer lens in young low-to-moderate myopes

Purpose

To evaluate visual and refractive outcomes and safety of implantable collamer lens (ICL) implantation in low-to-moderate myopia.

Setting

Private Practice – Dougherty Laser Vision, Westlake Village, CA, USA.

Methods

A chart review was performed in 56 (104 eyes) consecutive patients who underwent implantation of the Visian ICL V4 model. Inclusion criteria were age between 21 and 40 years, spherical equivalent between −3.00 D and −10.00 D, and cylinder up to −5 D. Data on visual acuity, refraction, and complications were collected.

Results

The mean time to the last postoperative visit was 13.1±14.0 months (range, 2 to 50 months). The mean preoperative spherical equivalent was −6.96±1.60 D and the mean preoperative cylinder was −1.03±0.88 D. The mean preoperative corrected distance visual acuity (CDVA) was 20/20 (range, 20/15 to 20/80) that remained unchanged at last postoperative visit. At the last postoperative visit, the spherical equivalent was −0.08±0.01 D and the cylinder was 0.29±0.71 D. Comparison of postoperative uncorrected distance visual acuity (UCDVA) to preoperative CDVA indicated that 27 eyes (26%) had better postoperative UCDVA and 61 eyes (59%) had UDVA equivalent to the preoperative CDVA. Postoperatively, 4 eyes lost 1 line of CDVA and no eyes lost >1 line of CDVA. There were 32 eyes that gained at least ≥1 of CDVA. There were no intraoperative complications. Postoperatively, 3 patients (6 eyes) had dry eye, and 1 patient complained of nighttime halos in 1 eye. At the last postoperative visit, there were no eyes with lens opacity or glaucoma.

Conclusion

ICL implantation for low and moderate myopia up to −10 D in patients up to 40 years of age was safe, accurate, and efficacious. ICL implantation may be a good alternative to laser in situ keratomileusis for young myopes less than −10.00 D.

Update on Treating High Myopia With Implantable Collamer Lenses

The purpose of this article is to provide updates on the treatment of high myopia with the implantable collamer lens (ICL). The ICL has become an important technique used in intraocular refractive surgery. With improvements in material, design, and application, the ICL has good efficacy, predictability, long-term safety and stability, manageable complications, and reversibility. More and more refractive surgeons are taking note of the ICL. This article reviews the material characteristics and the latest designs of the ICL along with the clinical applications, visual quality, and future development.

Anterior Chamber Angle Evaluation following Phakic Posterior Chamber Collamer Lens with CentraFLOW and Its Correlation with ICL Vault and Intraocular Pressure

Purpose. To assess intraocular pressure (IOP), lens vaulting, and anterior chamber (AC) angle width, following V4C implantable Collamer lens (ICL) procedure for myopic refractive error. Methods. A prospective case series that enrolled 54 eyes of 27 patients that were evaluated before and after V4C phakic posterior chamber Collamer lens implantation for correction of myopic refractive error. Preoperative measurement of IOP was done using Goldmann applanation tonometer and anterior chamber angle width using both Van Herick slit lamp grading system and Scheimpflug tomography imaging (Oculus Pentacam). Follow-up of the aforementioned variables was at 1, 6, and 18 months postoperatively, together with ICL vault measurements. Results. The mean baseline IOP of 11.69 ± 2.15 showed a statistically significant (P = 0.002) increase after 1 month that remained unchanged at 6 and 18 months postoperatively, with mean value of 16.07 ± 4.12, 16.07 ± 4.10, and 16.07 ± 4.13, respectively. Pentacam AC angle width showed a statistically significant decrease at 1 (P = 0.025), 6 (P = 0.016), and 18 (P = 0.010) months postoperatively, with mean preoperative value of 40.14 ± 5.49 that decreased to 25.28 ± 5.33, 25.46 ± 5.44, and 25.49 ± 5.38, at 1, 6, and 18 months, respectively. Mean ICL vault showed moderate correlation with Pentacam AC angle width at 1 (r = −0.435) and 6 (r = −0.424) months. Conclusion. V4C ICL implantation resulted in decrease in AC angle width and increase in IOP, within acceptable physiological values at all time points.