Abstract：Objective: To explore the causes of secondary operations such as phakic implantable collamer lens
(ICL) reposition, exchange or explantation after ICL implantation, further more to analyze its clinical
characteristics and outcomes. Methods: In this case serial study, 74 eyes of 73 patients with ametropia
who underwent ICL reposition, exchange or explantation in Zhengzhou Aier Eye Hospital from July
2017 to December 2020 were collected, composed of 47 eyes with ICL reposition, 26 eyes with ICL
exchange and 1 eye with ICL explantation. All patients were followed up with the examination including
uncorrected visual acuity (UCVA), vault and corneal endothelial density (ECD). Sixty-eight eyes with
simple implantation were used as the control group, meanwhile 47 eyes with ICL reposition and 26 eyes
with ICL exchange were defined as the reposition group and exchange group respectively. Independent
sample t-test was used to compare the vault changes between excessive vault and insufficient vault. One
way ANOVA was used to compare the differences of UCVA, effectiveness index, safety index and ECD
reduction among the reposition group, exchange group and the control group. The exchange rates of
ICL and TICL were compared by Chi-square test. Results: The causes of ICL reposition, exchange or
explantation include abnormal vault, TICL rotation and abnormal ICL position. Fifty-nine eyes underwent
ICL reposition or exchange due to abnormal vault, of which eyes with excessive vault achieved ideal vault
through reposition or smaller ICL exchange, while eyes with insufficient vault were relatively complex.
In addition, the average vault changes of ICL reposition or exchange in those with excessive vault was
greater than that in those with insufficient vault(t=4.72, P<0.001). There were 14 eyes with visual acuity
decreasing due to TICL rotation, of which 12 eyes had stable and good results after TICL reposition, and
2 eyes got unsatisfactory results after reposition treated by ICL exchange finally. There were no significant
difference in UCVA, effectiveness index, safety index and ECD reduction among the reposition group,
exchange group and the control group. The exchange rate of ICL (1.6%) was lower than that of TICL
(3.5%), and the difference was statistically significant (χ
2=4.04, P=0.045). For 1 eye whose ICL position
was abnormal and vault varied greatly from top to bottom in pupil area, ICL removal+phacoemulsification
+intraocular lens implantation brought satisfactory results. Conclusion: Abnormal vault is the main reason
of ICL reposition, exchange or explantation. The average vault changes of ICL reposition or exchange in
those with excessive vault was greater than that in those with insufficient vault, and shown better regularity.
After reposition of TICL rotation, satisfactory results can be obtained in most cases. Compared with simple
implantation, ICL reposition or exchange have considerable safety and outcomes.
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