DSAEK for implantable collamer lens dislocation and corneal decompensation 6 years after implantation

Multicenter survey on implantable collamer lens dislocation

This study aimed to investigate the incidence, patient background, and postoperative prognosis of implantable collamer lens (ICL) dislocation. We retrospectively reviewed all cases of ICL dislocation at four major refractive surgery centers in Japan until December 2019. The incidence, patient background, cause of dislocation, complications of repositioning surgery, and postoperative visual function were investigated. Seven ICL dislocations [0.072% of total ICL-implanted eyes (9775 eyes)] occurred at an average of 28.6 months (11–82 months) postoperatively. All patients were male. Five eyes were injured during sports activities, one due to a fall from a bicycle, and another due to ocular blunt trauma caused by a mortuary tablet. Two patients had re-dislocation in the same eye. Retinal detachment occurred after repositioning surgery in one patient, and scleral buckling surgery was performed without ICL removal. ICL dislocation is a rare complication of ICL surgery; repositioning surgery is effective, but retinal complications may occur.

Traumatic dislocation of an implantable phakic contact lens

Ocular trauma can range from trivial to significant, with varying implications on the visual acuity and prognosis. A 32-year-old woman presented with complaints of blurring of vision following blunt ocular trauma with a previous history of having undergone implantable phakic contact lens (IPCL V2.0) implantation 2 years back. The corrected distance visual acuity (CDVA) was 20/20 in the right eye and 20/30 in the left eye. Slit-lamp examination revealed a prolapse of inferonasal IPCL footplate into the anterior chamber with pupillary entrapment. No corneal endothelial touch was noted. Immediate repositioning of the IPCL was performed and the patient regained a CDVA of 20/20 in the left eye, postoperatively. Traumatic dislocation of IPCL is a rare occurrence, which can be successfully managed by prompt surgery, thus avoiding further complications like corneal endothelial decompensation.

Pupillary capture of implantable collamer lens after oral antidepressants

We report the case of a 26-year-old man under treatment with the antidepressant drugs olanzapine and buspirone, which are associated with anticholinergic effects, in whom an implantable collamer lens (ICL) became spontaneously dislocated. ICL dislocation and pupil capture occurred 10 months postoperatively. The lens was successfully repositioned. The possible role of these drugs in the dislocation of the ICL is discussed.

Recurrent prolapse of toric implantable collamer lens after blunt ocular trauma under mesopic conditions

Implantable collamer lenses (ICL) carry a risk of prolapse caused by direct ocular trauma, especially in mesopic conditions and when oversized ICLs are implanted. We recommend early surgical repositioning, as well as patient education that encourages goggle use during active sports.

Combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking to treat mild keratoconus: Long-term follow-up

PURPOSE

To report visual, refractive, and topographic outcomes of sequential, same-day small-incision lenticule extraction and intrastromal corneal collagen crosslinking (CXL) in eyes with mild keratoconus.

SETTING

Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico.

DESIGN

Prospective interventional case series.

METHODS

Fifteen eyes with forme fruste keratoconus and/or irregular corneas, corrected distance visual acuity 20/40 or better, stable refraction of at least 1 year, age 18 years or older, and residual corneal thickness of greater tan 400 μm before performing collagen crosslinking were studied. Patients were treated with small-incision lenticule extraction followed by intrastromal injection of riboflavin inside the pocket. Ultraviolet A light with a wavelength of 370 nm to 3 mW/cm(2) was applied for 30 minutes. Follow-up was done at 1 day, at 1 week, and at 1, 3, 6, 12, 18, and 24 months.

RESULTS

Eight patients were included in the study. The mean age was 29.5 years ± 5.5 (SD) (range 20 to 36 years). Twenty-four months of follow-up were completed in 13 eyes, and 12 months were completed in 2 eyes. Preoperative uncorrected distance visual acuity improved from 1.6 ± 0.3 LogMAR (Snellen 20/796) to postoperative 0.12 ± 0.20 LogMAR (Snellen 20/26) and was statistically significant (P < .001). Best-corrected distance visual acuity did not change significantly (P = .186), from 0.006 ± 0.02 LogMAR (Snellen 20/20) preoperatively to 0.04 ± 0.05 LogMAR (Snellen 20/21) postoperatively, and spherical equivalent improved from -4.3 ± 1.02 preoperatively to 0.2 ± 0.66 (P < .001).

CONCLUSION

Although further follow-up and larger samples are needed to fully confirm these findings, the results suggest that combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking are a promising treatment option for patients for whom conventional laser refractive surgery is contraindicated.

FINANCIAL DISCLOSURE

Drs. Ramirez-Miranda and Navas are consultants to Carl Zeiss Meditec. No other author has a financial or proprietary interest in any material or method mentioned.

Traumatic dislocation of implanted collamer phakic lens: a case report and review of the literature

Purpose :

Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after blunt trauma and review the published literature on this topic.

Methods :

Case report and literature review using PubMed.

Results :

A 44 year-old male presented to the emergency department with sudden onset of blurry vision after blunt trauma to the left eye. Three years prior, he had undergone bilateral ICL placement for high myopia. On examination, the superotemporal haptic was noted to be dislocated into the anterior chamber, but there was no endothelial touch by the dislocated lens. The patient had an associated hyphema that was medically managed, and 2 weeks after the injury, the patient underwent ICL repositioning. A review of the literature was performed and five previous cases of ICL dislocation were identified. Three of these occurred after blunt trauma. One of these cases was associated with endothelial touch and decompensation and eventually required a descement’s stripping endothelial keratoplasty (DSAEK).

Conclusion :

Dislocation of ICLs after blunt trauma is a rare but important potential sequela of the procedure and can lead to corneal decompensation if there is lens-endothelial touch. All patients who suffer blunt dislocation of ICL should be followed long-term after repositioning for signs of endothelial loss and dysfunction.

Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to −24 diopters (D) and 0 to −6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was −10.35 ± 5.1 D (+8 to −24) and the postoperative sphere was −0.09 ± 1.06 D (+3.25 to −6.5), p < 0.001. Preoperative cylinder was −2.63 ± 1.44 (0 to −6.5 D) and postoperative cylinder was −0.97 ± 0.89 D (0 to −3.5), p < 0.001. The preoperative mean spherical equivalent was −11.6 ± 5.12 D (+7.875 to −25.625) and postoperative spherical equivalent was −0.52 ± 1.03 (+2.25 to −6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.