Central Vault Research Articles

Pharmacological Accommodative Changes of Haptic Position and Its Impact on Vault After ICL Implantation.

To evaluate dynamic changes in ciliary parameters and Implantable Collamer Lens V4C (ICL) (STAAR Surgical) haptic position using mydriatic and miotic agents and their effects on the central and peripheral vault. This study involved 80 eyes from 40 consecutive patients (mean age: 28.05 years; range: 19 to 42 years) examined 3 months after ICL implantation. Patients were randomly assigned to either a mydriasis group or a miosis group. Ultrasound biomicroscopy was used to measure the following parameters at baseline and after pharmacological induction with tropicamide or pilocarpine: ciliary process length (CPL), iris ciliary angle (ICA), final tip point of the ICL haptic (ftICL haptic), central vault (c-vault), mid-peripheral vault (m-vault), and peripheral vault (p-vault). In the mydriatic group, the proportion of eyes with all ICL haptics in the ciliary sulcus increased from 70.0% to 77.5% after tropicamide administration, whereas in the miotic group, this proportion decreased from 67.5% to 57.5% after pilocarpine administration. The CPL and ftICL haptic increased significantly in the mydriatic group (all P < .01) but decreased in the miotic group (all P < 0.01). Conversely, the ICA decreased significantly in the mydriatic group and increased in the miotic group (all P < .01). The correlation analysis showed no significant relationship between changes in c-vault, m-vault, and p-vault with alterations in CPL, ICA, and ftICL haptic in both groups. Haptic position contributes to the movement of the ICL optical zone during accommodation, but changes in haptic position were not significantly correlated with changes in the vault. [J Refract Surg. 2025;41(1):e22-e28.].

Anterior Segment Pharmacological Accommodative Changes and Its Impact on the Circumferential Anterior Chamber Angle after ICL V4c Implantation: Angle following ICL implantation.

To investigate the pharmacological accommodative changes of the anterior segment and its impact on the circumferential anterior chamber angle (ACA) after implantable collamer lens (ICL) implantation using swept-source optical coherence tomography (SS-OCT). Eye and ENT Hospital, Fudan University, Shanghai, CHINA. Prospective randomized contralateral eye study. Eight men and 24 women (mean age, 28.2 ± 5.8 years; range, 19-42 years); 64 eyes were included at 3 months after ICL implantation. One eye per patient was randomly assigned to undergo tropicamide instillation (mydriasis group), and the contralateral eye underwent pilocarpine instillation (miosis group). SS-OCT examinations were performed before and after instillation to measure angle parameters. Trabecular-iris angle 500 (TIA500), angle opening distance 500 (AOD500), trabecular-iris space area (TISA500), angle opening distance circumference area 500 (AODA500), trabecular-iris circumference volume 500 (TICV500), and central vault (ICL to crystalline lens [ICL-L]) were evaluated. Relative to baseline levels, TIA500, AOD500, and TISA500 values all increased significantly in both groups (all P < 0.01). AODA500 and TICV500 values increased by 19.7% and 12.1%, respectively, in the mydriasis group (all P < 0.001), and these values similarly increased by 23.4% and 27.7%, respectively, in the miosis group (all P < 0.001). After instillation, the ICL-L decrease in the miosis group was significantly larger than that in the mydriasis group (P = 0.004). Mean AOD500, TISA500, and TICV500 in the miosis group were significantly larger than those in the mydriasis group (all P ≤ 0.036), especially at 8 and 10 o'clock (all P ≤ 0.014). Correlation analyses indicated that the increase in anterior chamber angle parameters was positively correlated with the change in ICL-L for both groups. Pilocarpine induced a more significant increase in ACA than tropicamide, because of different mechanism of anterior segment changes. We recommend circumferential meridian scan to assess angle status.

Assessment of clinical efficacy and safety of ICL implantation in patients with relatively shallow anterior chamber depth in early and midterm postoperative time

ObjectiveTo investigate the clinical effect and safety of Implantable Collamer Lens (ICL) implantation in myopic patients with relatively shallow anterior chamber depth (ACD). MethodsRetrospective analysis, comparative, non-interventional case series. Patients with myopia who underwent ICL implantation were included in the study and were categorized into two groups: one with a relatively shallow ACD (2.60 mm ≤ ACD ＜ 2.80 mm) and the other with a normal ACD (ACD ≥2.80 mm). Each group comprised 51 eyes and were reviewed for at least 6 months. To evaluate preoperative and postoperative visual acuity, intraocular pressure (IOP), central vault, ACD, endothelial cell density (ECD) and anterior chamber angle parameters [ trabecular iris angle (TIA), angle opening distance at 500 μm and 750 μm (AOD500, AOD750), trabecular iris space area at 500 μm and 750 μm (TISA500, TISA750) ]. Analyze the trend of postoperative data changes of 1 week, 1 month, 3 months, and at least 6 months. Patients in relatively shallow ACD with vault <100 μm or >1000 μm were performed detailed follow-up. ResultsThe postoperative uncorrected distance visual acuity (UDVA) and best corrected visual acuity (BCVA) surpassed the preoperative BCVA in two groups. The group differences of effectiveness index (EI) was p = 0.409 and of safety index (SI) was p = 0.563. The EI were 1.07 and 1.09, SI were1.10 and 1.21. Postoperative vision and refractive error were effectively corrected. The preoperative and postoperative IOP and ECD values of the two groups were within the normal range, and the preoperative and postoperative differences and the group differences of IOP and ECD were p = 0.649, p = 0.501, p = 0.222, p = 0.276. The ACD in two groups were reduced by approximately 25 % and 26 %, the nasal and temporal TIA were reduced to 45 % and 50 % approximately. The nasal and temporal AOD500, AOD750, TISA500, and TISA750 in the relatively shallow ACD group were reduced 40 % approximately and in the normal ACD group were reduced to 30 % approximately. All the preoperative and postoperative differences and the group differences of anterior segment parameters were statistically significant (all p < 0.01), with more significant anterior segment changes in normal ACD group.The postoperative data in two groups showed that when the follow-up time was prolonged, the central vault was decreasing, and the postoperative ACD was increasing, the postoperative TIA increased slowly in relatively shallow ACD group and decreased slowly in normal ACD group, temporal TIA were greater than nasal TIA, with no significant variation. There were four eyes in the relatively shallow ACD group in the remarkable abnormal postoperative central vault. Three eyes had second operation: one eye had an ICL alignment, and two eyes had ICL replacement. ConclusionPatients with relatively shallow ACD who underwent ICL implantation had fine postoperative clinical efficacy and safety.

Impact of an enterprise controlled substance management system on labor and inventory costs.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate the impact of an enterprise controlled substance (ECS) management system with integration of analytics software on labor requirements and inventory cost within a health-system pharmacy. A prospective, pre-post observational study was designed to assess the impact of implementing a solution that connects disparate systems with the integration of analytics software. Three study modules were implemented over approximately 18 months. The intervention consisted of implementation of new CS vaults, a centralized server, an automated central medication inventory system, and inventory optimization analytics software. The number of transactions and time spent on CS reports were compared before and after implementation to determine labor and inventory efficiencies. Both of the study facilities had a decrease in CS daily stockouts and an increase in inventory turns compared to baseline, while the total number of transactions (vends) at the central vault and decentralized dispensing cabinets increased. The addition of analytics allowed for establishment of informed changes to periodic automated replenishment levels. Additionally, both facilities saw a reduction in the number of expired medications, and there was subsequently a reduction in the total reverse distributor costs. Finally, both facilities had a reduction in the amount of time spent on manual tasks associated with reconciling and managing discrepancies. An inventory management system integrated with an advanced analytics tool provided a reduction in the time spent on receiving, storing, and reconciling CS records while the number of transactions increased. The ECS solution enhanced the visibility of the chain of custody while closing the loop between reporting and receiving inventory, eliminating or reducing the frequency of manual processes.

Characterization of vault with two models of posterior chamber phakic intraocular lenses.

To evaluate and compare dynamic vault range (DVR) and asymmetry of the vault during a 3-month follow-up after the implantation of 2 posterior chamber phakic intraocular lenses (pIOLs). Aver Clinic, Madrid, Spain. Prospective comparative study. 119 eyes (65 patients) that underwent refractive surgical correction with implantation of 1 of 2 distinct pIOLs were enrolled: Eyecryl Phakic from Biotech Vision Care (Eyecryl group, 72 eyes) and Evo Visian Implantable Contact Lens from Staar Surgical (ICL group, 47 eyes). Besides evaluation of visual acuity, refraction, and ocular integrity, the pIOL vault centrally and at 2 mm nasally and temporally as well as the DVR from photopic (50 lux) to mesopic (10 lux) illumination conditions were measured. No significant differences were found between the pIOL groups in visual and refractive outcomes ( P ≥ .454). No significant differences between the groups were found in central (523.72 ± 168.4 vs 494.16 ± 156.7 μm, P = .248) and temporal (499.43 ± 155.8 vs 431.28 ± 150.5 μm, P = .067) vaults. However, nasal vault was significantly lower in the ICL group (465.6 ± 149.1 vs 375.4 ± 144.0 μm, P = .045). A trend of a larger DVR was observed in the ICL group, although differences between groups did not reach statistical significance (54.00 ± 36.39 vs 86.5 ± 57.9 μm, P = .070). The pIOL diameter only correlated significantly with vault measurements in the ICL group ( r ≥ 0.650, P < .001). The Eyecryl pIOL showed more symmetric vaults and a trend of fewer light-induced changes in the central vault compared with the ICL pIOL. The clinical relevance of this finding should be investigated further.

Rotational Stability, Footplate Position, and Visual Outcomes of Toric Implantable Collamer Lenses in Eyes With Low Vault.

To evaluate the clinical outcomes, rotational stability, and footplate position of the toric Implantable Collamer Lens (TICL) (STAAR Surgical) in eyes with low vault and analyze factors related to rotational stability. This prospective observational study included 59 eyes of 59 patients with insufficient vault (< 250 µm). Postoperative rotation was defined as the difference between the achieved angle and the intraoperative fixation angle, and assessed with a digital anterior segment photograph after full mydriasis at 1 week and 1, 3, and 6 months postoperatively. Ultrasound biomicroscopy was used to determine the ciliary body morphology and position of the footplate. Correlation analysis was employed to identify the risk factors associated with TICL rotation at 6 months postoperatively. At 6 months postoperatively, the mean central vault was 137.4 ± 61.0 µm (range: 40 to 236 µm), and the mean efficacy and safety indices were 1.04 and 1.15, respectively. The mean manifest refractive astigmatism decreased from -1.67 ± 0.82 diopters (D) preoperatively to -0.43 ± 0.33 D postoperatively, and the mean absolute rotation was 4.50 ± 3.08 degrees (range: 0 to 12.50 degrees). The angle of rotation was correlated with the preoperative spherical power (r = -0.318, P = .014), the average value of TICL footplates position (r = 0.284, P = .029), and postoperative astigmatism (r = -.469, P⩽ .001). TICL implantation is predictable, safe, and effective in correcting myopic astigmatism in eyes with low vault. The rotational stability was acceptable and related to the malposition of the footplate and preoperative spherical power. [J Refract Surg. 2024;40(7):e460-e467.].

The Collapse of the Vaults of the Ambato Matriz Church in the 1949 Earthquake: A Response with a Technical Approach

This research examines the structural behavior of the central vault of the Matriz church that collapsed during the 1949 earthquake in Ambato, Ecuador. Following the disaster, the church and Episcopal Palace were demolished. The central vault lacked buttresses and had large cracks two years before the collapse. A study was conducted using graphic restitution and the theory of limit analysis of structures to analyze the mechanical behavior of the central vault. The aim was to provide a technical explanation for the cause of the collapse beyond the impact of the earthquake. The limit analysis of structures is a tool that determines the technical stability conditions of a masonry structure using graphic statics. In this case, the respective checks of the structural behavior could be made, concluding that the structural ensemble of the central vault was unstable and could have collapsed at any moment, not necessarily due to an earthquake. The article is based on the research project “Architectural analysis of the central nucleus of Ambato between 1895 and 1949: styles, types, techniques, losses, and continuities”, which was conducted at the Universidad Técnica de Ambato, Ecuador, from 2021 to 2023.

Cerastecins inhibit membrane lipooligosaccharide transport in drug-resistant Acinetobacter baumannii.

Carbapenem-resistant Acinetobacter baumannii infections have limited treatment options. Synthesis, transport and placement of lipopolysaccharide or lipooligosaccharide (LOS) in the outer membrane of Gram-negative bacteria are important for bacterial virulence and survival. Here we describe the cerastecins, inhibitors of the A. baumannii transporter MsbA, an LOS flippase. These molecules are potent and bactericidal against A. baumannii, including clinical carbapenem-resistant Acinetobacter baumannii isolates. Using cryo-electron microscopy and biochemical analysis, we show that the cerastecins adopt a serpentine configuration in the central vault of the MsbA dimer, stalling the enzyme and uncoupling ATP hydrolysis from substrate flipping. A derivative with optimized potency and pharmacokinetic properties showed efficacy in murine models of bloodstream or pulmonary A. baumannii infection. While resistance development is inevitable, targeting a clinically unexploited mechanism avoids existing antibiotic resistance mechanisms. Although clinical validation of LOS transport remains undetermined, the cerastecins may open a path to narrow-spectrum treatment modalities for important nosocomial infections.

Seven-Year clinical outcomes after implantation of Eyecryl posterior chamber phakic intraocular lenses for high myopia.

To evaluate the long-term clinical outcomes, safety and efficacy of Eyecryl posterior-chamber phakic intraocular lens implantation (pIOL) implantation in patients with high myopia. Patients with myopia between -6.00 and -20.00 dioptres and with endothelial cell density (ECD) was ≥2300 cells/mm2 were included. Preoperative and postoperative first, fourth, and seventh years of refraction, uncorrected/corrected distance visual acuity (UDVA/CDVA), ECD, central vault were detected. Thirty-six eyes were analyzed. The mean UDVA and CDVA in postoperative seventh years were 0.25 ± 0.31 and 0.13 ± 0.24 logMAR, respectively. The safety and efficacy indices were 1.55 ± 0.54 and 1.24 ± 0.53, respectively. The mean cumulative ECD loss was 6.96% (p < 0.001). The central vault at the 1st and the 7th year were 0.52 ± 0.14 and 0.49 ± 0.14 mm, respectively (p = 0.25). These findings supported the long-term stability, efficacy, safety of the Eyecryl pIOL for high myopia. Eyecryl posterior chamber pIOL is one of the effective refractive options in correcting high myopia.

Repeatability and Agreement of Central Vault for Implantable Collamer Lens Obtained by the Tomey OA‐2000 Biometer and Spectralis OCT

Objective. To assess repeatability and agreement of central vault for implantable collamer lens (ICL) measured by the Tomey OA‐2000 biometry and Spectralis optical coherence tomography (OCT). Methods. In this prospective study, the central vault was measured by the Tomey OA‐2000 biometer and Spectralis OCT in 84 eyes (43 patients) after ICL implantation at six month follow‐up. Three consecutive scans were obtained by one experienced technician using Tomey OA‐2000 and the Spectralis OCT in the same day. The coefficient of variation (CoV), intraclass correlation coefficient (ICC), within‐subject standard deviation (Sw), and 2.77 Sw were calculated to assess the repeatability and reproducibility. The paired t‐test and Bland–Altman plots were used to analyze the differences and agreements of central vault measured by two devices. Results. Repeatability of the central vault measured by Tomey OA‐2000 biometer and Spectralis OCT showed that the CoV was 2.71% and 1.66%, respectively. The ICC for both devices was 0.996 and 0.999, respectively. The paired t‐test showed that central vault measured by Tomey OA‐2000 biometer was −7.25 ± 23.57 microns lower than that measured by Spectralis OCT (P = 0.006). The mean difference between measurements for Tomey OA‐2000 and ASM‐OCT with 95% limits of agreement (LoAs) was −38.94 to 53.44 μm. Conclusion. Both Tomey OA‐2000 biometer and Spectralis OCT displayed good repeatability for the measurement of central vault of ICL. Good reliability and agreement were observed between Tomey OA‐2000 biometer and Spectralis OCT. Both instruments are useful but not replaced each other for central vault measurements.

Comparison of Dynamic Vault Changes Following Implantation of Two Different Models of Phakic Intraocular Lenses.

To compare the dynamic vault range (the difference in the central vault height from scotopic to photopic light condition) after implantation of the ICL/TICL (STAAR Surgical) and Eyecryl phakic/Eyecryl phakic toric intraocular lens (IOL) (Biotech Healthcare). This retrospective study included patients with myopia or myopic astigmatism eligible for phakic IOL implantation with either the ICL/TICL or Eyecryl phakic/Eyecryl phakic toric IOL. Vault changes in varying light conditions (scotopic, mesopic, and photopic) were assessed using an anterior segment optical coherence tomography-based tomographer and dynamic vault range (DVR) was compared between the two groups. A total of 60 eyes from 36 patients (30 eyes in each group) with a mean age of 28.63 ± 6.36 years were included. The mean postoperative follow-up at the time of assessment was 9.4 ± 5.3 and 8.9 ± 5.28 months (P = .75) in the ICL and Eyecryl groups, respectively. The mean values of scotopic, mesopic, and photopic vault were 490.56 ± 238.64, 453.56 ± 224.30, and 373.96 ± 200.24 μm in the ICL group and 515.46 ± 174.34, 490.26 ± 184.04, 450.43 ± 173.92 μm in the Eyecryl group (P = .32, .24, and .05, respectively). The DVR was 116.6 ± 59.29 μm in the ICL group versus 65.03 ± 31.78 μm in the Eyecryl group (P < .001). The Eyecryl phakic IOL showed significantly fewer light-induced changes in the central vault height (DVR) compared to the ICL, which may be attributed to the difference in the material of the two phakic IOL models. This may be clinically significant in eyes with low postoperative vaults with respect to their follow-up and risk assessment of cataractogenesis in the long term. [J Refract Surg. 2023;39(8):546-554.].

Reconstructing the fallen arch of Notre-Dame. New insights into Gothic vault-building

During the fire in April 2019, part of the central vaulting of the nave of Notre-Dame de Paris collapsed beneath the impact of the fallen spire. The blocks composing the transverse arch were decontaminated, then subjected to archeological examination prior to attempting to dry-mount them (i.e., without mortar) on the ground. The purpose was to collect as much information as possible about the arch itself (its state of conservation, geometry, fashioning of the blocks, assembly, etc.), to consider the possibility of putting the fallen stones back in their original places, and more broadly to improve knowledge about mediaeval cathedral vaulting.This article describes the method used during this mounting, which took place in winter 2020/21. Five criteria of differing kind and importance guided decisions on where to place the voussoirs, which way round to position them, and which to associate with which. Three were taken into consideration from the outset, with the interpretation of two of these changing over time: the non-standardized dimension of the voussoirs (their thickness), the presence of a cross mark on one of the joint faces, and the presence of rectangular notches on the extrados of the blocks for housing the end of a centering system for constructing the vault compartments. Two other criteria were incorporated as work progressed, pertaining to the order in which the blocks were collected after the fire, and the geological facies of the stones, thus introducing the idea of degree of confidence.By the end of this operation, only four blocks had been placed with certainty. Nevertheless, the criteria thereby defined and their weighting have been used as a starting point for other investigation methods. In terms of archaeology, the observations carried out on this arch in these exceptional conditions suggest we should reconsider the dating of the nave vaulting, while throwing light more broadly on the relative chronology of building works on this landmark monument of Gothic architecture.

Deep Learning–Based Estimation of Implantable Collamer Lens Vault Using Optical Coherence Tomography

To develop and validate a deep learning neural network for automated measurement of implantable collamer lens (ICL) vault using anterior segment optical coherence tomography (AS-OCT). Cross-sectional retrospective study. Multicentric. A total of 2,647 AS-OCT anonymized eye scans were used from 139 eyes of 82 subjects who underwent ICL surgery in 3 different centers. Using transfer learning, a deep learning neural network algorithm was trained and validated for the regression task of estimating the ICL vault on the MS-39 OCT (CSO, Florence, Italy). A trained operator separately reviewed all OCT scans and measured the central vault using a built-in OCT caliper tool. The model was then separately tested on 191 AS-OCT scans. A Bland-Altman plot was constructed and the mean absolute percentage error (MAPE), the mean absolute error (MAE), the root mean squared error (RMSE), the Pearson correlation coefficient (r), and the determination coefficient (R2) were calculated to evaluate the strength and validity of the model. On the test set, the model achieved a MAPE of 3.42%, an MAE of 15.82 µm, an RMSE of 18.85 µm, a Pearson correlation coefficient r of +0.98 (P-Value < .00001), and a coefficient of determination R2 of +0.96. There was no significant difference between the vaults of the test set labeled by the technician versus those estimated by the model: 478 ± 95 µm versus 475 ± 97 µm, respectively, P-Value = 0.064). Using transfer learning, our deep learning neural network was able to accurately compute the ICL vault from AS-OCT scans, overcoming the limitations of an imbalanced dataset and limited training data. Such an algorithm can assist the postoperative assessment in ICL surgery. PRéCIS: This study develops and validates a deep learning model to accurately estimate implantable collamer lens vault on optical coherence tomography using transfer learning, convoluted neural networks, and regression.

Three-Dimensional Quantitative Description of the Implantable Collamer Lens in the Ocular Anterior Segment of Patients With Myopia

To describe the 3-dimensional (3D) location of the implantable collamer lens (ICL) quantitatively in the posterior ocular chamber of patients with myopia. Cross-sectional study. To obtain visualization models before and after mydriasis, an automatic 3D imaging method based on swept-source optical coherence tomography was created. Parameters like the ICL lens volume (ILV), the tilt of the ICL and crystalline lens, the vault distribution index, and topographic maps were evaluated to describe the ICL location. Using a paired sample t test and the Wilcoxon signed rank test, the difference between nonmydriasis and postmydriasis conditions was compared. The study investigated 32 eyes from 20 patients. The 3D central vault did not differ significantly before (P=.994) or after mydriasis (P=.549) compared with the 2D central vault. After mydriasis, the 5-mm ILV decreased by 0.85 mm2 (P=.016), and the vault distribution index increased significantly (P=.001). The ICL and the crystalline lens exhibited tilt (nonmydriasis: ICL total tilt 3.78 ± 1.85 degrees, lens total tilt 4.03 ± 1.53 degrees; postmydriasis: ICL total tilt 3.84 ± 1.56 degrees, lens total tilt 4.09 ± 1.64 degrees). The phenomenon of asynchronous tilt of the ICL and lens was found in 5 eyes, leading to the spatially asymmetric distribution of the ICL-lens distance. The 3D imaging technique provided exhaustive and reliable data for the anterior segment. The visualization models offered multiple perspectives on the ICL in the posterior chamber. Before and after mydriasis, the intraocular ICL position was described by the 3D parameters.

Assessment of Central Vault Changes induced By Cyclopentolate In Myopic Patients Implanted with the Implantable Phakic Contact Lens®

Background A safe alternative to excimer laser in fixing high myopia is the implantable phakic contact lens (IPCL). Cycloplegics have been found to produce vault changes in the implantable collamer lens but not tested yet for the IPCL. Purpose To analyze central vault changes linked with instillation of cyclopentolate in myopic IPCL implanted patients and its association with anterior chamber depth (ACD), pupillary diameter, and white-to-white (WTW) diameter. Patients and methods This prospective study assessed the left eyes of 37 patients. Patients were followed up for 3 months postoperatively. The basic outcome measures were the safety and efficacy indices, while the main outcome was the vault measurements before and after cyclopentolate. Results Twenty (54.1%) females and 17 (45.9%) males, with a mean age of 24±4 years (18–32) were recruited. The safety index was 1.08±0.07 and the efficacy index was 0.99±0.1. There was a significant increase in central vault ‘V(C)’ after cyclopentolate [83.7±86.7 μm (−48 to 303); P&lt;0.001). A good positive correlation existed between V(C) and ACD (r=0.7, P&lt;0.001), and a fair correlation with pupil diameter (r=0.4, P=0.014), WTW (r=0.39, P=0.017), and the original vault ‘V(B)’ (r=0.34, P=004) was demonstrated. Conclusion Cyclopentolate induces an increase in central vault in most IPCL implanted myopic eyes, which is typically associated with ACD, pupillary diameter, WTW, and the original vault. Care should be advised to avoid angle narrowing.

Descriptive Analysis of Footplate Position After Myopic Implantable Collamer Lens Implantation Using a Very High-Frequency Ultrasound Robotic Scanner.

To assess the position of the haptics of the implantable collamer lens (ICL) in myopic eyes using a high-frequency ultrasound robotic scanner. This was a prospective, single-arm, observational study carried out at the Instituto Zaldivar SA (Mendoza, Argentina) in a sample of 52 eyes who have been submitted to successful ICL implantation prior to enrollment. Images of the eyes were obtained using a very-high frequency digital ultrasound robotic scanner (VHFDU) to establish the position of the ICL in the posterior chamber and its relation to the ciliary sulcus. New parameters for lens position analysis were also described. In 81% of cases (42 eyes), the ICL rests on the ciliary body (CB) in both temporal and nasal sides, being slightly lower than 6% (3 eyes) those that rest on the sulcus in both sides, with significant correlations between ICL position and vault values (p<0.05). Cases in which the ICL position was CB-CB yielded central vault values across the whole range determined within the sample, but most of the eyes where the ICL rests on both the sulcus in one side and the CB in the other yield greater central vault values. Correlation was significant between ICL position and retroposition distance on the temporal side (Spearman's rho -0.487, p<0.001). A significant but weaker correlation was also found between ICL position and retroiridian space (p<0.05). ICL for myopia footplates tend to locate outside of the sulcus in a significant percentage of patients after successful implantation. VHFDU assessment in eyes implanted with an ICL to properly study the lens footplate position and posterior anatomical relations provides important additional information besides post-surgery vault.

Inter-eye and postoperative prediction of vault after implantation of EVO + Visian phakic implantable collamer lens.

To assess whether the postoperative outcomes of the implantation of an EVO + implantable collamer lens (ICL) in one eye can be used as a predictor of the vault of the fellow eye, and to evaluate the vault changes of the implantation in both eyes during the postoperative period. A prospective study including 40 eyes of 20 patients with a bilateral EVO + ICL implantation was performed. Subjects were evaluated before the surgery and 1 day, 1 week and 1, 3 and 6 months postoperatively. Central vault was assessed using spectral-domain optical coherence tomography. The inter-eye and follow-up analyses were performed using lineal models and the Bland-Altman method. The vault of the first implanted eye at the 1-day visit highly predicts the vault of the second eye (R2 = .87; P < .001); the mean inter-eye difference was - 0.95μm, and the superior and inferior limits of agreement were -50.27μm and 148.37μm, respectively. This relationship was maintained during the medium-term follow-up, not finding differences in the slopes among visits (P ≥ .09). A progressive decrease of vault was found during the follow-up (P < .001). Larger vault change 6months after the surgery was associated with higher vault 1 day after the ICL implantation (R2 = .19;P = .005). One-day postoperative vault in the first eye can help to predict the optimal ICL sizing in the second eye. Vault tends to decrease during the first 6months after EVO + ICL implantation. Eyes with higher initial vaults will also show larger reductions during the medium-term follow-up.

Efficacy and safety after posterior chamber Implantable Collamer Lens implantation according to preoperative anterior chamber depth: Short-term comparative study.

To compare visual, refractive, and safety outcomes of posterior chamber Implantable Collamer Lens (ICL) implantation for the correction of myopia according to the preoperative anterior chamber depth (ACD). Retrospective, comparative study, patients submitted to implantation of myopic posterior-chamber phakic Implantable Collamer Lens (ICL), model V4C/V5, minimum follow-up of 12 months; two groups were created: Group 1 (ACD 2.80 to 2.99 mm) and Group 2 (ACD equal to or greater than 3.00 mm). The parameters evaluated were uncorrected and corrected visual acuity, subjective refraction, efficacy and safety index, predictability, endothelial cell density, central vault, anterior chamber angle and postoperative complications. A total of 558 eyes from 298 patients were evaluated: 111 eyes (19.9%) in group 1 and 447 eyes (80.1%) in group 2. At 12 months, the efficacy index was similar in both groups (p = 0.264); the safety index was higher in group 1 (p = 0.031); the mean central Vault was significantly lower in group 1 (212.8 vs 410.6 μm; p < 0.001). Respectively, 93 (83.8%) and 366 (84.1%) eyes were within ±0.50 D of targeted refraction. Anterior chamber angle significantly decreased during follow-up in both groups (p < 0.001; p < 0.001). Intraocular pressure did not change significantly (p = 0.310 and p = 0.446, respectively). There were no significant differences in endothelial cell density loss (p = 0.278) or in the rate of complications observed (p = 0.733). ICL implantation is an effective and safe procedure in eyes with shallow anterior chambers, with visual and refractive results and complication rates identical to those obtained in deeper anterior chambers.

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain

ObjectivesTo analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. MethodThis is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. ResultsA sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was −6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of −7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of −0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of −0.92 ± 2.80 mmHg. ConclusionsICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

Mechanical analysis of the impact of the morphology of the iris and ciliary body on the central vault after posterior chamber phakic intraocular lens implantation

Objective: To investigate the impact of the iris and ciliary body morphology on the central vault after phakic posterior chamber intraocular lens (pIOL) implantation. Methods: This research was based on the retrospective analysis of 123 patients (123 eyes) who underwent pIOL implantation in the Department of Ophthalmology, Affiliated Hospital of Qingdao University between June 2018 and June 2020. The anterior segment structure was observed with an ultrasound biomicroscope before surgery, and all morphological parameters of the iris and ciliary body were measured manually using the ImageJ software, including iris span (IS), iris convexity (IC), iris-ciliary body contact distance (ICCD) and iris-lens contact distance (ILCD). The ICCD was divided into Q1, Q2 and Q3 groups according to the equidistant distance of 0.36 mm. The lens thickness was measured with the IOLMaster. The horizontal corneal diameter and anterior chamber depth were measured using the Pentacam. The central vaults were measured by optical coherence tomography at 1 week, 3 months and 1 year after surgery. The relationships between vault values and preoperative parameters of the anterior segment were evaluated using the Pearson correlation analysis, Spearman correlation analysis, and multiple linear regression. The repeated measures ANOVA was applied to identify changes of vault values over time. Results: The mean values of the vaults at 1 week, 3 months and 1 year after surgery were (723±265) μm, (642±255) μm and (613±280) μm, respectively. The difference among them was statistically significant (F=50.143, P<0.001). The vaults continued to decline within 1 year after pIOL implantation, and the total decline was (122±86) μm. The vaults declined by (69±98) μm from postoperative 1 week to 3 months and by (52±54) μm from postoperative 3 months to 1 year. The regression formula showed that the pIOL size and ILCD were positively related with the vault, while the LT, IS and IC were negatively related with the vault at 1 week postoperatively (adjusted R²=0.404, P<0.001). The pIOL size and ILCD were positively related with the vault, while the IS and IC were negatively related with the vault at 3 months postoperatively (adjusted R²=0.342, P<0.001). The pIOL size was positively related with the vault, while the IS and IC were negatively related with the vault at 1 year postoperatively (adjusted R²=0.661, P<0.001). The vault values were higher in group Q3 compared to group Q1 at every timepoint, and the vault value was higher in group Q2 compared to Q1 at 1 year postoperatively. Conclusions: In the early postoperative period, eyes with a larger pIOL, shorter iris span, longer contact distance between the iris and ciliary body, and longer contact distance between the iris and lens were associated with a higher rate of excessive vaults. Meanwhile, eyes with a thicker lens and larger iris reverse convexity were more likely to obtain insufficient vaults. Within one year after surgery, the pIOL size, IS, IC and ICCD continued to impact on the vault. The ICCD, ILCD and IC can reflect the posterior chamber volume and change the haptic location and force, thus affecting the vault.