Abstract：Objective: To analyze the factors that may lead to an abnormal vault after implantation of the implantable collamer lens (ICL). Methods: This research was based on the retrospective analysis of sixty patients (67 eyes) who underwent ICL V4c replacement after collamer lens implantation with a V4c lens in the Chengdu Aier Eye Hospital between November 2014 and November 2017. The replacement was performed because of abnormal vaults of the initial lens implantations, either less than 250 μm or more than 750 μm. Seventy patients (70 eyes) were randomly chosen as the control group from those who underwent ICL implantation during the same period and had normal vaults (250 to 750 μm). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, intraocular pressure (IOP), corneal endothelial cell density (ECD), and lens thickness (LT) were measured before surgery. The posterior chamber angle, height of the ciliary processes (T value), sulcus-to-sulcus (STS) horizontal distance, STS vertical distance, and anterior chamber depth (ACD) were measured by an ultrasound biomicroscope (UBM). All patients were followed more than 6 months. UCVA, manifest refraction, BCVA, IOP, ECD, and vault height were measured. Data were analyzed using a t-test and multiple linear regression. Results: There were significant differences between the high vault group and the low vault group for posterior chamber angle and ICL size and ACD (all P<0.001). There were significant differences between the high vault group and normal vault group for ICL size and posterior chamber angle. Posterior chamber angle, ICL size, STS horizontal distance, T value, ACD, and LT were statistically significant factors for the abnormal vault (adjusted, R2=0.608, F=5.84, P<0.001). Eight eyes had a vault less than 250 μm after implantable collamer lens replacement in the low vault group. Whereas the vault was normal after ICL replacement in all eyes of the high vault group. There were no serious complications such as anterior subcapsular cataract, high intraocular pressure, or corneal endothelial decompensation during the observation period. Conclusions: Multiple ciliary sulcus factors affect vault after ICL implantation. T value, posterior chamber angle, STS horizontal distance, ACD, ICL size, and LT may be related to an abnormal vault. For cases where abnormal vault may occur, the ICL size can be determined in conjunction with the posterior angle to help achieve a proper vault.
Kamiya K, Shimizu K, Igarashi A, et al.Posterior chamber phakic intraocular lens implantation: comparative, multicentre study in 351 eyes with low-to-moderate or high myopia. Br J Ophthalmol, 2018, 102(2): 177-181. DOI: 10.1136/bjophthalmol-2017-310164.
Bhandari V, Karandikar S, Reddy JK, et al.Implantable collamer lens V4b and V4c for correction of high myopia. J Curr Ophthalmol, 2015, 27(3-4): 76-81. DOI: 10.1016/j.joco. 2016.01.001.
[4]
Chang JS, Meau AY.Visian Collamer phakic intraocular lens in high myopic Asian eyes. J Refract Surg, 2007, 23(1): 17. DOI: 10.1097/01.ijg.0000212292.93292.80.
[5]
Garcia-De la Rosa G, Olivo-Payne A, Serna-Ojeda JC, et al. Anterior segment optical coherence tomography angle and vault analysis after toric and non-toric implantable collamer lens V4c implantation in patients with high myopia. Br J Ophthalmol, 2018, 102(4): 544-548. DOI: 10.1136/bjophthalmol-2017- 310518.
[6]
Steinwender G, Varna-Tigka K, Shajari M, et al.Anterior subcapsular cataract caused by forceful irrigation during implantation of a posterior chamber phakic intraocular lens with a central hole. J Cataract Refract Surg, 2017, 43(7): 969-74. DOI: 10.1136/bjophthalmol-2017-310518.
[7]
Khalifa YM, Goldsmith J, Moshirfar M.Bilateral explantation of visian implantable collamer lenses secondary to bilateral acute angle closure resulting from a non-pupillary block mechanism. J Refract Surg, 2010, 26(12): 991-994. DOI: 10.3928/1081597X-20100521-01.
Guber I, Chokri L, Majo F.Preoperative sizing of the TICL (Toric Implantable Collamer Lens): The largest was too small!. Klin Monbl Augenheilkd, 2012, 229(4): 457-458. DOI: 10.1055/s-0031-1299221.
[10]
Lisa C, Naveiras M, Alfonso-Bartolozzi B, et al.Posterior chamber collagen copolymer phakic intraocular lens with a central hole to correct myopia: One-year follow-up. J Cataract Refract Surg, 2015, 41(6): 1153-1159. DOI: 10.1016/j.jcrs.2014. 10.030.
[11]
Miao H, Chen X, Tian M, et al.Refractive outcomes and optical quality after implantation of posterior chamber phakic implantable collamer lens with a central hole (ICL V4c). BMC Ophthalmol, 2018, 18(1): 141. DOI: 10.1186/s12886-018-0805-3.
[12]
Fernandes P, González-Méijome JM, Madrid-Costa D, et al.Implantable collamer posterior chamber intraocular lenses: A review of potential complications. J Refract Surg, 2011, 27(10): 765-776. DOI: 10.3928/1081597X-20110617-01.
[13]
Seo JH, Kim MK, Wee WR, et al.Effects of white-to-white diameter and anterior chamber depth on implantable collamer lens vault and visual outcome. J Refract Surg, 2009, 25(8): 730-738.
Lee H, Kang D, Choi JY, et al.Analysis of pre-operative factors affecting range of optimal vaulting after implantation of 12.6-mm V4c implantable collamer lens in myopic eyes. BMC Ophthalmol, 2018, 18(1): 163. DOI: 10.1186/s12886-018-0835-x.
[16]
Zeng QY, Xie XL, Chen Q.Prevention and management of collagen copolymer phakic intraocular lens exchange: Causes and surgical techniques. J Cataract Refract Surg, 2015, 41(3): 576-584. DOI: 10.1016/j.jcrs.2014.06.036.
[17]
Qi MY, Chen Q, Zeng QY.The effect of the crystalline lens on central vault after implantable collamer lens implantation. J Refract Surg, 2017, 33(8): 519-523. DOI: 10.3928/1081597X-20170602-02.
Sanders DR.Incidence of lens opacities and clinically significant cataracts with the implantable contact lens: Comparison of two lens designs. J Refract Surg, 2002, 18(6): 673-682. DOI: 10.1055/s-2002-36502.
[22]
Pavlin CJ, Ritch R, Foster FS.Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol, 1992, 113(4): 390-395.
[23]
Shields RA, Lorek BH, Krueger RR.Ciliary sulcus microcysts as the source of a white-to-white sizing mismatch with the implantable collamer lens. J Refract Surg, 2015, 31(3): 209-210. DOI: 10.3928/1081597X-20150224-06.
[24]
Aman-Ullah M, Gimbel HV, Camoriano GD. Toric implantable collamer lens implantation in a case with bilateral primary peripheral iris cysts. Ophthalmic Surg Lasers Imaging, 2012, 43 Online: e18-21. DOI: 10.3928/15428877-20120223-01.
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