Indications for explant of implantable collamer lens

Effects of brimonidine tartrate 0.2 and 0.15% ophthalmic solution on the static and dynamic pupil characteristics

Aims

To investigate the differences between 0.2 and 0.15% brimonidine tartrate eye drops for anti-mydriatic effects and the optical quality under different light conditions.

Methods

This prospective study involved 80 consecutive high myopia patients undergoing implantation of a V4c ICL. The patients were randomly instilled with brimonidine 0.2 and 0.15% 2 weeks postoperatively. Visual quality, pupil center, pupil size, and refraction under different light conditions were measured before and 0.5 h after brimonidine administration. A symptom questionnaire was also evaluated.

Results

There was no statistical difference in the static and dynamic pupil diameters and velocity after LS between the two groups (p > 0.05). The 0.2% group had significant changes in pupil center before and after treatment, while there was no obvious movement of the 0.15% group under all illumination condition (p > 0.05). The OSI after treatment of the 0.15% group was lower than that of 0.2% group (p = 0.012). The PVA9% and PVA100% of the 0.15% group was higher than that of 0.2% group in the dark (p = 0.009, p = 0.012). The HOA RMS of the 0.15% group was lower than that of 0.2% group (p = 0.016). The QIRC score in the 0.15% group was significantly higher than that in the 0.2% group (p = 0.043).

Conclusion

0.15 and 0.2% brimonidine tartrate eye drops had similar anti-mydriatic ability, while 0.15% group had better visual quality than 0.2% concentration, and hardly introduced pupil shift. 0.15% brimonidine tartrate eye drops may be more suitable for patients with nocturnal glare symptoms in the early postoperative period after ICL implantation.

Postoperative vault prediction for phakic implantable collamer lens surgery: LASSO formulas

PURPOSE

To develop and evaluate reliable formulas for predicting postoperative vault more accurately after implantable collamer lens (ICL) surgery in a White patient population with varying degrees of ametropia.

SETTING

Private clinical practice.

DESIGN

Retrospective analysis on dataset split into a separate training and test set.

METHODS

115 eyes of 59 patients were used to train regression models predicting postoperative vault based on anterior segment optical coherence tomography (OCT) parameters (Least Absolute Shrinkage and Selection Operator [LASSO]-OCT formula), ocular biometry data (LASSO-Biometry formula), or data from both devices (LASSO-Full formula). The performance of these models was evaluated against the manufacturer's nomogram (Online Calculation and Ordering System [OCOS]) and Nakamura 1 (NK1) and 2 (NK2) formulas on a matched separate test set of 37 eyes of 19 patients.

RESULTS

The mean preoperative spherical equivalent was -5.32 ± 3.37 (range: +3.75 to -17.375 diopters). The mean absolute errors of the estimated vs achieved postoperative vault for the LASSO-Biometry, LASSO-OCT, and LASSO-Full formulas were 144.1 ± 107.9 μm, 145.6 ± 100.6 μm, and 132.0 ± 86.6 μm, respectively. These results were significantly lower compared with the OCOS, NK1, and NK2 formulas ( P < .006). Postoperative vault could be estimated within 500 μm in 97.3% (LASSO-Biometry) to 100% of cases (LASSO-OCT and LASSO-Full).

CONCLUSIONS

The LASSO suite provided a set of powerful, reproducible yet convenient ICL sizing formulas with state-of-the-art performance in White patients, including those with low to moderate degrees of myopia. The calculator can be accessed at http://icl.emmetropia.be .

Correlation between intraoperative and postoperative vaulting of the EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system

Background

Implantable Collamer lens (ICL) vaulting is one of the most important parameters for the safety, aqueous humor circulation, and lens transparency after ICL implantation. This study aimed to investigate the factors associated with the actual vaulting after refractive EVO-ICL surgery.

Methods

This retrospective study included patients who underwent EVO-ICL surgery at a tertiary eye hospital between October and December 2019. A RESCAN 700 was used for the intraoperative and CIRRUS HD-OCT was used for postoperative observation of vaulting. Subjective and objective refractions, anterior ocular segment, corneal morphology, intraocular pressure (IOP), anterior chamber volume (ACV), crystalline lens rise (CLR), white-to-white distance (WTW), anterior chamber depth (ACD), axial length, corneal endothelial cell density (ECD), and fundoscopy were examined. A multivariable analysis was performed to determine the factors independently associated with 1-month postoperative vaulting.

Results

Fifty-one patients (102 eyes) were included. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P = 0.039), lower preoperative corrected visual acuity (P = 0.006), lower preoperative IOP (P = 0.029), higher preoperative ACD (P = 0.004), lower preoperative CLR (P = 0.046), higher ICL spherical equivalent (P = 0.030), higher intraoperative vaulting (P < 0.001), and lower IOP at 1 month (P = 0.045). The multivariable analysis showed that the only factor independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio = 1.005, 95% confidence interval: 1.002–1.007, P < 0.001). The intraoperative and 1-month postoperative vaulting values were positively correlated (R² = 0.562).

Conclusions

The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value of ICL at 1 month.

Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM

To evaluate the causes of phakic implantable collamer lens (ICL) exchange/explantation in patients with and without keratoconus (KC) at two tertiary hospitals in Riyadh, Saudi Arabia.

METHODS

A retrospective chart review of all patients who underwent ICL (model V4c with central port) exchange/explantation was performed using the electronic medical record systems. All available preoperative and postoperative data were documented for each patient.

RESULTS

Over 7y, 2283 ICL implantation procedures were performed; 46 implants (2%) required exchange (21 implants)/explantation (25 implants), of which 14 cases (30.4%) were patients with KC. Indications for ICL exchange/explantation in non-KC group were vault measurement, cataract formation, increased intraocular pressure, inaccurate refraction, and patient dissatisfaction in 22 (68.75%), 4 (12.5%), 3 (9.37%), 2 (6.25%), and 1 (3.12%) case, respectively. The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients (78.57%), inaccurate refraction in 2 patients (14.28%), and patient dissatisfaction postoperatively in 1 (7.14%) case.

CONCLUSION

ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature. Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.

Visual and Refractive Outcomes With the Eyecryl Phakic Toric IOL Versus the Visian Toric Implantable Collamer Lens: Results of a 2-Year Prospective Comparative Study

PURPOSE

To compare the 2-year visual and refractive outcomes with the Eyecryl Phakic Toric IOL (EP TIOL) (Biotech Vision Care Pvt Ltd) and Visian Toric ICL (TICL) (STAAR Surgical) for correction of high myopic astigmatism.

METHODS

This prospective, interventional, non-randomized comparison study included eligible patients who underwent toric phakic IOL surgery in one or both eyes with either the EP TIOL or TICL for myopic astigmatism. Two years postoperatively, both lenses were compared for their safety, efficacy, stability, and patient satisfaction. Vector analysis of astigmatism was performed using the Alpins method with the ASSORT software (ASSORT Party Ltd).

RESULTS

A total of 50 eyes were included, of which 25 eyes received EP TIOL implantation and the remaining 25 received TICL implantation. Preoperative mean ± standard deviation of spherical equivalent (SE) and cylinder was -10.15 ± 4.04 and -2.08 ± 0.86 diopters (D) in the EP TIOL group and -10.21 ± 3.97 and -2.17 ± 0.95 D in the TICL group, respectively. At 2 years of follow-up, there was no significant difference between the mean uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, and residual astigmatism between the two groups (P > .05 for all parameters). Ninety-two percent of eyes in the EP TIOL group and 88% of eyes in the TICL group were within ±0.50 D of refractive astigmatism. Vector analysis of astigmatism showed a comparable Correction Index of 0.98 in the EP TIOL group and 0.94 in the TICL group, signifying a mild undercorrection of 2% and 6%, respectively. Two eyes in the TICL group underwent exchange for high vault and one eye required realignment due to significant postoperative rotation.

CONCLUSIONS

At least for the first 2 years postoperatively, both toric phakic IOLs were safe and effective in managing high myopic astigmatism with comparable visual results and patient satisfaction. [J Refract Surg. 2021;37(1):7-15.].

A Case of Implantable Collamer Lens (ICL) with Reverse Orientation for 10 Years

Background

Implantable collamer lens (ICL) might rarely cause complications that warrant explantation. Here, we presented a case of inverted ICL that has undergone explantation after a 10-year duration. Case Presentation. A 49-year-old male with past ocular history of ICL implantation 10 years ago presented complaining of progressive decrease of visual acuity in the left eye for a long time. On examination, decreased visual acuity, anterior subcapsular cataract, and low ICL vault were noted. The anterior segment optical coherence tomography (AS OCT) showed inverted ICL. The ICL was explanted, and cataract surgery was done.

Conclusion

Inverted ICL should be kept in mind as a rare cause of long-term poor visual acuity in patient with a history of ICL surgery.

Safety and efficacy of toric implantable collamer lens V4c model - A retrospective South Indian study

Purpose:

The aim of this study was to evaluate the safety, efficacy, and complications of V4c Toric implantable collamer Lens (TICL) implantation for myopic astigmatism in the south Indian population.

Methods:

In this retrospective observational case series, a total of 109 eyes of 67 patients who underwent V4c TICL implantation (ICL, V4C Staar Surgical, Nidau, Switzerland) between January 2012 and August 2019 were studied with a minimum follow-up period of 6 months (mean 24 months). The main outcome measures were objective and subjective refraction, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), safety, predictability, adverse events, and postoperative complications.

Results:

At 6 months, mean manifest refractive spherical equivalent (SE) decreased from - 10.90 ± 3.7D preoperatively to - 0.02 ± 0.13D postoperatively (P < 0.001) and mean cylinder decreased from - 2.3 ± 1.3 D preoperatively to - 0.04 ± 0.2 D postoperatively (P < 0.001). Postoperatively, SE within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 96.3 (105 eyes) and 100% (109 eyes), respectively. Manifest refractive cylinder within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 97.2 (106 eyes) and 100% (109 eyes), respectively. Sixty-two percent (68 eyes) showed no change in CDVA postoperatively, and no eye had lost lines of CDVA. The safety index was 1.12, and the efficacy index was 1.10. Complications were seen in two eyes (1.8%) due to high postoperative vault requiring secondary surgical interventions.

Conclusion:

V4c TICL is a highly effective, safe, and predictable option in treating myopic astigmatism with excellent improvement in vision and spectacle independence.