Optimization of the lens sizing for the second eye based on the vault obtained in the first eye in bilateral myopic collamer phakic intraocular lens surgery

Abstract

Abstract Purpose To assess vault and the decision-making process involved in selecting the size of the lens for the fellow eye in a series of patients who received bilateral phakic collamer intraocular lens (pIOL) implants with central hole for correction of myopia. Methods The study sample included all patients who underwent bilateral insertion of a different size pIOL from a pool of 269 patients who underwent sequential bilateral insertion of a pIOL from March 2012 to May 2015 in our institution. Procedures were separated in time to assess the value of the vault and select the pIOL size in second eyes. Vault was analyzed objectively using optical coherence tomography. Results The decision to change the size of the pIOL in the fellow eye was taken in 25 patients. A smaller pIOL was implanted in the second eye in 9 patients, whereas a lens that was 1 size larger was necessary in 16 patients. Implantation of a larger lens led to a mean increase in vault of 251 ± 180 μm; implantation of a smaller size lens led to a mean decrease in vault of 542 ± 187 μm. In five patients, the pIOL implanted in first eye was rotated vertically to reduce lens vault. No lenses had to be explanted. Conclusions Vault in fellow eyes can be improved in patients receiving bilateral myopic pIOL implants by modifying the pIOL size based on the vault value obtained in the first eyes.