Implantable Collamer Lens Surgery Research Articles

Early clinical outcome with lens position adjustment following implantable collamer lens surgery.

To observe early clinical outcome with lens position adjustment following the implantable collamer lens (ICL) surgery. Sixty patients were selected for this retrospective study. One eye from each patient received Toric ICL for astigmatism correction, and the other received non-astigmatic ICL surgery using horizontal position. Patients with higher postoperative arch height were selected, and their non-astigmatic eye clinical outcome were observed after ICL surgery at 1wk, 1, and 3mo. The clinical measurements included uncorrected visual acuity (UCVA), intraocular pressure (IOP), refractive state, corneal endothelium cell count, and arch height. Three months later, the ICL in each patient's non-astigmatic eye was adjusted to the vertical from the horizontal position. The results were compared before and 1wk, 1, and 3mo after adjustment. UCVA and IOP were significantly reduced 1wk after position adjustment compared to 1wk after ICL implantation (P<0.05). The patients demonstrated significantly reduced arch height and corneal endothelium cell count 1wk, 1, and 3mo after adjusting position compared to 1wk, 1, and 3mo after ICL implantation (P<0.05). However, there was no significant difference in refraction between 1wk, 1, and 3mo after ICL implantation and position adjustment (P>0.05). Early positioning adjustment post-phakic ICL implantation can benefit patients with adjusted arch height or higher IOP. Despite the good clinical effects, the doctors should pay attention to the potential for adverse effects on UCVA and corneal endothelium cells following early position adjustment after posterior chamber phakic ICL implantation.

Comparison of rotational stability of the Implantable Collamer Lens after using a vertical or horizontal implanting orientation.

To compare rotational stability of the Implantable Collamer Lens (ICL) between horizontal and vertical implantation. Zhongshan Ophthalmic Center, China. Prospective 1:1 matched design. 94 cases (185 eyes with a vertical elliptical ciliary sulcus) were included with a 1:1 matched design based on ciliary sulcus morphology, preset deviation angle, and vault. Follow-ups at 4 days, 1 month, 3 months, and 6 months post-surgery measured rotational angles using slit-lamp photography. Latent class trajectory modeling was employed to investigate the postoperative rotational angle trajectories. Six months after surgery, both groups exhibited similar visual acuity and refractive outcomes. The horizontal group had a significantly greater rotation angle than the vertical group (F group = 13.638, P < 0.001). Additionally, a statistically significant difference (P = 0.004) in the average trajectories of rotational angles was observed. The vertical group displayed a greater presence in the low-stable trajectory subgroup while demonstrating a reduced presence in the moderate-increase and high-fluctuation trajectory subgroups compared to the horizontal group. The horizontal group had a 3.750 times higher risk of rotation angle ≥3° compared to the vertical group, which represented a statistically significant difference (95% CI: 1.346∼10.446). In both groups, a positive correlation between the preset deviation angle and the rotation angle was observed, with correlation coefficients of 0.320 (P = 0.030) and 0.371 (P = 0.011), respectively. Vertical ICL implantation showed better rotational stability than horizontal implantation in eyes with a vertical elliptical ciliary sulcus, offering guidance for ICL surgery.

Effect of lighting conditions on implantable collamer lens vault: Influence of anterior chamber and lens parameters

PurposeTo investigate the change in the vault of the implantable collamer lens (ICL) under dark-to-light conditions and its association with anterior chamber and lens parameters in patients undergoing ICL surgery. MethodsIn 76 eyes from 40 patients, preoperative anterior chamber volume (ACV), pupil diameter (PD), anterior chamber angle, central corneal thickness (CCT), white-to-white (WTW), lens thickness (LT), axial length (AL), spherical equivalent (SE) and patient's age were collected. Postoperative vault, PD and LT were measured under dark and light conditions using anterior segment optical coherence tomography (CASIA2; TOMEY, Japan), and changes and lens displacement under dark-to-light conditions were calculated. Mixed-effects models were used to analyze the correlation between the vault change and the anterior chamber and lens parameters of all subjects and the high-vault subgroup. ResultsThe vault under light condition (648.36 ± 304.47 μm) was significantly smaller compared to the vault under dark condition (708.89 ± 316.15 μm). In all patients, vault change increased with the increase of age, lens displacement and PD change; and increased with the decrease of ACV, LT change and baseline vault (under dark condition). In the high-vault subgroup, vault change increased with the increase of CCT, lens displacement and PD change; and increased with the decrease of ACV. ConclusionsICL vault changes significantly from dark to light, influenced by age, ACV, PD change, LT change, lens displacement, and baseline vault. A higher baseline vault is correlated with a larger LT change, affecting the levels of accommodation under dark-to-light transition.

Development and validation of a novel vault prediction formula based on structural parameters of the anterior and posterior chambers

BackgroundAccurate prediction of postoperative vault in implantable collamer lens (ICL) implantation is crucial; however, current formulas often fail to account for individual anatomical variations, leading to suboptimal visual outcomes and necessitating improved predictive models. We aimed to verify the prediction accuracy of our new predictive model for vaulting based on anterior and posterior chamber structural parameters.MethodsThis retrospective observational study included 137 patients (240 eyes) who previously underwent ICL surgery. Patients were randomly divided into the model establishment (192 eyes) or validation (48 eyes) groups. Preoperative measurements of the anterior and posterior chamber structures were obtained using Pentacam, CASIA2 anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy, and other devices. Stepwise multiple linear regression analysis was used to evaluate the relationship between the vault and each variable (WL formula). The Friedman test was performed for the vaulting prediction results of the WL, NK (Ver. 3), and KS formulas (Ver. 4) in CASIA2 AS-OCT, as well as the Zhu formula and vault measurements. The proportions of prediction error within ± 250 μm per formula were compared.ResultsThe predicted vault values of the WL, NK, KS, and Zhu formulas and vault measurements were 668.74 ± 162.12, 650.85 ± 248.47, 546.56 ± 128.99, 486.56 ± 210.76, and 716.06 ± 233.84 μm, respectively, with a significant difference (χ2 = 69.883, P = 0.000). Significant differences were also found between the measured vault value and Zhu formula, measured vault value and KS formula, WL formula and Zhu formula, WL formula and KS formula, NK formula and KS formula, and NK formula and Zhu formula (P < 0.001) but not between other groups. The proportions of prediction error within ± 250 μm per formula were as follows: WL formula (81.3%) > NK formula (70.8%) > KS formula (66.7%) > Zhu formula (54.2%).ConclusionsThe WL formula, which considers the complexity of the anterior and posterior chamber structures, demonstrates greater calculation accuracy, compared with the KS (Ver. 4) and Zhu formulas. The proportion of absolute prediction error ≤ 250 μm is higher with the WL formula than with the NK formula (ver. 3). This enhanced predictive capability can improve ICL sizing decisions, thereby increasing the safety and efficacy of ICL implantation surgeries.

Correction of Internal Astigmatism Using Toric Scleral Contact Lens after Implantable Collamer Lens Surgery

Purpose: We present a case of internal astigmatism correction using a toric scleral contact lens in a patient with high myopia after implantable collamer lens (ICL) surgery.Case summary: A 45-year-old man presented with a significant decrease in visual acuity despite previous ICL surgery. Initial attempts to fit a corneal rigid gas permeable contact lens to the left eye were unsuccessful due to fitting challenges. Subsequently, the use of a spherical scleral contact lens effectively corrected corneal astigmatism but failed to address internal astigmatism, thereby limiting improvement in visual acuity. Postoperative corneal ectasia and ICL rotation were suspected to be the underlying causes of this astigmatism. The introduction of a front toric scleral lens resulted in a significant improvement in visual acuity and sustained comfort throughout the 3-month follow-up period.Conclusions: The use of toric scleral lenses can significantly improve visual acuity and provide exceptional comfort in cases where corneal morphology and lens position change after ICL surgery. This modality presents a promising alternative for future consideration.

Influence of implantable Collamer lens implantation on choroidal thickness and blood flow density

Objective: To observe the impact of implantable Collamer lens (ICL) implantation surgery on choroidal thickness and blood flow density in myopic patients. Methods: This was a prospective cohort study. Patients undergoing ICL surgery at Qingdao University Affiliated Hospital between June 2021 and May 2023 were consecutively enrolled. Patients were categorized into high myopia (HM) and super high myopia (SHM) groups based on whether their spherical equivalence power exceeded 10.00 D. Comprehensive ophthalmic examinations, including optical coherence tomography, optical coherence tomography angiography, visual acuity assessment, intraocular pressure measurement, and optometry, were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results: A total of 42 patients (84 eyes), with an average age of (25.27±3.18) years, comprising 11 males and 31 females, were enrolled in the study. Among them, 20 patients belonged to the HM group, while 22 patients were in the SHM group. Both choroidal thickness and blood flow density exhibited significant increases at postoperative 1 week and 1 month compared to preoperative levels (P<0.05), but returned to baseline levels by postoperative 3 months. Specifically, the subfoveal choroidal thickness increased from (169.49±61.57) μm preoperatively to (180.16±66.61) μm at 1 week, (186.69±63.32) μm at 1 month, and then reverted to (169.58±60.82) μm at 3 months. The central choroidal blood flow density showed changes from 60.03%±1.60% preoperatively to 61.04%±1.17% at 1 week, 60.42%±1.81% at 1 month, and 60.22%±1.57% at 3 months. Furthermore, the HM group exhibited more pronounced changes in both choroidal thickness and blood flow density across all time points compared to the SHM group. Significant differences were observed in choroidal thickness changes at various areas at 1 month, while changes in blood flow density in specific areas were significant. However, no significant differences were noted at 3 months postoperatively. Correlation analysis revealed a negative correlation of changes in subfoveal choroidal thickness and central choroidal blood flow density postoperatively at 1 week and 3 months with preoperative choroidal blood flow density. Notably, no correlation was found between preoperative choroidal thickness and postoperative changes. Conclusions: In the early period following ICL implantation, the increase in choroidal thickness and blood flow density may be more pronounced in HM compared to SHM, but the two parameters can return to baseline levels by 3 months. ICL implantation transiently affects the fundus microenvironment in myopic patients, with implications of preoperative choroidal blood flow.

Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up.

To investigate the factors associated with and impact on the femtosecond-assisted (FS-assisted) limbal relaxing incision (LRI) combined with the steep-meridian tri-planar clear corneal incision (TCCI) to reduce astigmatism in patients undergoing Implantable Collamer Lens (ICL) surgery. Retrospective case series. The study reviewed patients with ICL surgery combined with FS-assisted LRIs paired with steep-meridian TCCIs. Correlation analysis examined the relationship between independent variables, including preoperative characteristics (intraocular pressure, corneal thickness, axial length, et al.), TCCI, and LRI surgical parameters. The predictors of surgically induced astigmatism (SIA) were determined using individual-level analysis and accounting for inter-eye correlation with the generalized estimating equation (GEE). The study enrolled 69 patients, with 114 eyes (55 right and 59 left). The mean spherical equivalent (SEQ) was - 10.29 ± 2.99D and - 9.99 ± 2.72D for the right and left eye, respectively, while the mean preoperative corneal astigmatism was - 1.54 ± 0.47D and - 1.54 ± 0.46D for the right and left eyes, respectively. After 12 months of follow-up, univariate analysis revealed significant correlations between SIA and intraocular pressure (IOP), astigmatism type, TCCI position (degree), peripheral corneal thickness (PCT), LRI arc incision diameter, post depth (%), and angle, respectively (P = 0.046, 0.016, 0.039, 0.040, 0.009, 0.000, 0.000). Multivariate analysis using GEE demonstrated that axial length (AL), astigmatism type, LRI arc diameter, and angle were independent predictors of SIA (P = 0.000, 0.005, 0.029, 0.000). The type of astigmatism and axial length were independent factors that affected SIA when modifying the LRI arc diameter and angle through FS-assisted steep-meridian TCCI paired with LRI in ICL surgery.

A Deep Learning Model for Automatically Quantifying the Anterior Segment in Ultrasound Biomicroscopy Images of Implantable Collamer Lens Candidates

ObjectiveThis study aimed to develop and evaluate a deep learning-based model that could automatically measure anterior segment (AS) parameters on preoperative ultrasound biomicroscopy (UBM) images of implantable Collamer lens (ICL) surgery candidates. MethodsA total of 1164 panoramic UBM images were preoperatively obtained from 321 patients who received ICL surgery in the Eye Center of Renmin Hospital of Wuhan University (Wuhan, China) to develop an imaging database. First, the UNet++ network was utilized to segment AS tissues automatically, such as corneal lens and iris. In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks (ALs) of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA), and sulcus-to-sulcus distance (STS). Based on the results of the latter two processes, PD, ACD, ATA, and STS can be measured. Meanwhile, an external dataset of 294 images from Huangshi Aier Eye Hospital was employed to further assess the model's performance in other center. Lastly, a subset of 100 random images from the external test set was chosen to compare the performance of the model with senior experts. ResultsWhether in the internal test dataset or external test dataset, using manual labeling as the reference standard, the models achieved a mean Dice coefficient exceeding 0.880. Additionally, the intra-class correlation coefficients (ICCs) of ALs’ coordinates were all greater than 0.947, and the percentage of Euclidean distance distribution of ALs within 250 μm was over 95.24%.While the ICCs for PD, ACD, ATA, and STS were greater than 0.957, furthermore, the average relative error (ARE) of PD, ACD, ATA, and STS were below 2.41%. In terms of human versus machine performance, the ICCs between the measurements performed by the model and those by senior experts were all greater than 0.931. ConclusionA deep learning-based model could measure AS parameters using UBM images of ICL candidates, and exhibited a performance similar to that of a senior ophthalmologist.

Immediate Sequential Bilateral Implantable Collamer Lens Surgery Is Safe and Effective.

To assess the clinical outcomes and safety profiles of patients who underwent immediate sequential bilateral phakic lens surgery. This retrospective multicenter study included 254 consecutive patients (508 eyes) who underwent bilateral same-day Implantable Collamer Lens (ICL) (STAAR Surgical) surgery. The authors focused on 1-year postoperative clinical outcomes and adverse events. In the initial cohort, 176 patients (352 eyes) met inclusion criteria. Of these, 335 eyes underwent myopic ICL placement, and 17 eyes received a hyperopic ICL. Notably, 87% of eyes achieved ±0.50 diopters (D) and 95% achieved ±1.00 D of the intended refraction. One year postoperatively, 78% of eyes demonstrated optimal vaulting (250 to 750 µm), with a significant 19% reduction in vaulting observed over the 12 months (P < .001). Only minor adverse events, including early cataract formation (1 case), secondary toric ICL rotation (3 cases), and ICL exchange due to inappropriate vaulting (6 cases), were noted. The findings corroborate the safety and efficacy of immediate sequential bilateral phakic lens surgery and indicate its potential as a treatment option. The low incidence of minor adverse events further reinforces its favorable safety profile. [J Refract Surg. 2024;40(5):e313-e320.].

Corneal Sub-Basal Nerve Plexus Regeneration Pattern following Implantable Collamer Lens Implantation for Myopia: A Prospective Longitudinal In Vivo Confocal Microscopy Study.

Implantable Collamer Lens (ICL) surgery has increasingly been adopted for myopia correction in recent decades. This study, employing in vivo confocal microscopy (IVCM), aimed to assess the impact of corneal incision during ICL surgery on the corneal sub-basal nerve plexus (SNP) and adjacent immune dendritiform cells (DCs). In this longitudinal study, eyes from 53 patients undergoing ICL surgery were assessed preoperatively and postoperatively over a twelve-month period. Quantification of seven SNP parameters was performed using ACCMetrics V.2 software. Ultimately, the final analysis was restricted to one eye from each of the 37 patients who completed a minimum of three months' postoperative follow-up. Preoperative investigations revealed a positive correlation of DC density with patient age and a negative association with corneal nerve fiber density (CNFD). Additionally, both DCs and CNFD were positively linked to spherical equivalent refraction (SER) and inversely related to axial length (AL). Intriguingly, preoperative DC density demonstrated an indirect relationship with both baseline and postoperative CNFD changes. Post-surgery, an initial surge in DC density was observed, which normalized subsequently. Meanwhile, parameters like CNFD, corneal nerve fiber length (CNFL), and corneal nerve fractal dimension (CNFrD) initially showed a decline following surgery. However, at one-year follow-up, CNFL and CNFrD displayed significant recovery, while CNFD did not return to its baseline level. This study thus delineates the regeneration pattern of SNP and alterations in DC density post-ICL surgery, highlighting that CNFD in the central cornea does not completely revert to preoperative levels within a year. Given these findings, practitioners are advised to exercise caution in older patients, those with high myopia, or elevated preoperative DCs who may undergo delayed SNP regeneration.

Causes and management strategies for elevated intraocular pressure after implantable collamer lens implantation.

With the widespread application of Implantable Collamer Lens (ICL) implantation surgery in the field of myopia correction, a comprehensive understanding of its potential complications, especially those related to intraocular pressure (IOP), becomes crucial. This article systematically reviews various complications that may lead to IOP elevation after ICL surgery. Firstly, common complications after ICL surgery, including residual viscoelastic, steroid response, and excessive vault of the ICL, are detailed, emphasizing their potential impact on intraocular pressure. Regarding residual viscoelastic, we delve into its direct relationship with postoperative elevated IOP and possible preventive measures. For steroid response, we stress the importance of timely adjustment of steroid therapy and monitoring intraocular pressure. Additionally, excessive vault of the ICL is considered a significant potential issue, and we elaborate on its mechanism and possible management methods. In further discussion, we focus on relatively rare complications such as Toxic Anterior Segment Syndrome (TASS), Urrets-Zavalia Syndrome (UZS), Pigment Dispersion Syndrome (PDS), and malignant glaucoma. For these relatively rare complications, this review thoroughly explores their potential mechanisms, emphasizes the importance of prevention, and provides guidance for early diagnosis and treatment. This is a comprehensible review that aims to offer eye care professionals a comprehensive understanding and effective management guidance for complications of elevated IOP after ICL surgery, ultimately providing optimal care for patients' visual health.

Clinical decision support system based on deep learning for evaluating implantable collamer lens size and vault after implantable collamer lens surgery: a retrospective study

ObjectivesTo aid doctors in selecting the optimal preoperative implantable collamer lens (ICL) size and to enhance the safety and surgical outcomes of ICL procedures, a clinical decision support system (CDSS)...

Comparative evaluation of multiple nomograms for predicting postoperative vault after implantable collamer lens surgery.

To compare the vault predictability of most available implantable collamer lens (ICL) sizing nomograms and identify which preoperative measurements are predictive of vault. Private practice in Draper, Utah. Retrospective chart review. This study was a retrospective analysis of 209 eyes of 106 patients who underwent STAAR Surgical ICL implantation. Analyses were performed based on the availability of preoperative parameters, varying the number of eyes for each test. Mean absolute error (MAE) of predicted vs actual postoperative vault was calculated for each nomogram. The frequency of Kim, Rocamora (least absolute shrinkage and selection operator-optical coherence tomography), Russo, and Reinstein recommending the correct ICL size in instances when Parkhurst, optimized white-to-white (WTW), and STAAR could not recommend a definitive ICL size was determined. Univariate and multivariate linear regression analysis was performed between preoperative measurements and vault. The Kim, Rocamora, Russo, and Reinstein nomograms had significantly lower MAE of predicted vs actual postoperative vault than the KSV2 and Nakamura V3 nomograms. The Russo formula most frequently recommended the correct ICL size when the Parkhurst, Optimized WTW, and STAAR nomograms could not provide ICL size recommendations. At the 0.05 significance level, anterior chamber depth (ACD), ciliary body inner diameter (CBID), and pupil diameter were the parameters found to have significant correlation with postoperative vault. The Kim, Rocamora, Russo, and Reinstein nomograms were the most predictive of vault. Additionally, ACD, CBID, and pupil diameter were found to be significantly correlated with vault and should be considered for use in future ICL sizing nomograms.

From inception to innovation: bibliometric analysis of the evolution, hotspots, and trends in implantable collamer lens surgery research.

As one of several refractive surgeries, Implant Collamer Lens (ICL) surgery offers stable biocompatibility and consistent, high-quality visual outcomes. ICL has become an effective complement to corneal refractive surgery, gradually becoming one of the mainstream methods for correcting refractive errors. This study employs bibliometric methods to analyze research on ICL surgery to understand the progress, hotspots, and potential future trends in this field. This study performed a bibliometric analysis of all ICL-related articles collected from the Web of Science Core Collection database between January 1st, 1996, and December 31st, 2023. The CiteSpace 6.2.R4 tool, Excel and the Web of Science website were used to analyze data by country, institution, keywords, and clusters of keywords. Additionally, an in-depth interpretation and analysis were conducted on the field's high-impact articles. Since the first clinical application report of ICL, there have been a total of 875 studies. The number of papers published annually has shown an overall increasing trend. Studies published from China are the most numerous, accounting for 29.14% (n = 255) of the total. Among the institutions, Fudan University and Kitasato University both have published more than 50 papers, with Kitasato University having the highest H-index of 26. The journals with the top 10 publication volumes are all specialized in ophthalmology. The burst keywords since the introduction of ICL surgery have been "intraocular lens," "refractive surgery," and "cataract surgery." The current burst keywords include "visual quality," "vector analysis," "axial length," etc. The results of keyword clustering included ICL, pIOL, high myopia, axial length, optical quality, refractive surgery, ICL implantation, and pupil size. In the High-impact Articles, it was found that the high-impact articles predominantly focus on the safety, efficacy, and predictability of ICL surgery. Research on ICL has grown since its clinical introduction, with the advent of the central hole ICL sparking a surge in recent hotspots, particularly in China. Current hotpots in the field of ICL surgery are "visual quality," "ICL implantation," "vector analysis," "axial length," "evo ICL," "ICL v4c," and "ICL." ICL surgery research trends have evolved from implantation techniques to biological parameters associated with ICL surgery and the benefits of new ICL designs.

Comparison of Predictability in Vault Using NK Formula and KS Formula for the Implantable Collamer Lens Surgery.

This study aims to investigate the agreement between the NK and KS formulas in predicting the vault after implantation of an EVO-implantable collamer lens (ICL). This retrospective study included 106 eyes of 57 patients who underwent ICL-V4c implantation. Preoperative vault prediction was conducted by utilizing the NK and KS formulas, with postoperative measurements by anterior segment optical coherence tomography (AS-OCT) at one month. The analysis focused on the consistency between predicted and achieved vaults, as well as the correlation between the achieved vault and various biometric parameters. The mean achieved vault was 605.25 ± 212.72 µm, which was significantly smaller than the predicted vaults of 710.08 ± 195.08 and 673.80 ± 212.76 µm, using the NK and KS formulas, respectively (P < 0.05). The mean differences between the achieved vault and the predicted vault using the NK formula and KS formula were -104.82 μm (95% LoA: -600.38-391.19 μm) and -68.55 μm (95% LoA: -628.91-491.82 μm), respectively. Anterior chamber depth (ACD), vertical sulcus-to-sulcus (V-STS) diameter, and crystalline lens rise (CLR) were independent factors associated with the achieved vault (P < 0.05). The two formulas showed no statistically significant difference in absolute prediction error (APE). The NK formula exhibited superior consistency and low predictive error compared to the KS formula in the 12.6 mm ICL group. AS-OCT measurements overestimated the predicted ICL vault, especially in the 13.2 mm ICL size selection. Relying solely on the NK or KS formulas for predicting vaults before ICL surgery is not recommended.

Ocular features in myopic eyes with longer horizontal ciliary sulcus diameters for intended implantable collamer lens surgery.

To assess the ocular anterior segment characteristics in myopic eyes intended for ICL surgery with horizontal ciliary sulcus-to-sulcus (STS) diameters being greater than vertical STS diameters. This retrospective, comparative case study included 1230 eyes of patients who underwent ICL implantation for the treatment of myopia or myopic astigmatism at the Zhongshan Ophthalmic Center from September 2020 to November 2021. The myopic eyes were divided into two groups according to the relatively long diameter of the ciliary sulcus. General parameters and anterior chamber parameters were compared between the two groups. 1230 eyes of 694 patients were included. The proportion of myopic eyes with longer horizontal STS diameters was 4.63%. Horizontal STS distances exceeding vertical meridians in these eyes were mainly attributed to the shortening of vertical STS distances (horizontal STS: P = 0.112; vertical STS: P < 0.001). Eyes with longer horizontal meridians of the ciliary sulcus displayed larger steep keratometry value (P = 0.001), larger corneal volume (P = 0.002), larger corneal astigmatism (P < 0.001), larger ocular residual astigmatism (P = 0.017), worse visual acuity (logMAR UDVA: P = 0.021; logMAR CDVA: P = 0.001), and more iridociliary cysts (P = 0.017) compared to eyes with vertically oval shapes. Myopic eyes with longer horizontal STS diameters are commonly accompanied by a change in corneal morphology and more iridociliary cysts. The anatomical features of the ciliary sulcus should be given sufficient consideration to ICL size and placement selection, contributing to more personalized and precise surgery.

Successful antibiotic management of Staphylococcus epidermidis endophthalmitis after implantable collamer lens implantation

PurposeWe report a case of successful medical management of endophthalmitis post implantable collamer lens (ICL) culture-positive of Staphylococcus epidermidis.Observations: A 18-year-old female presented with decreased visual acuity in the left eye 20 days after ICL implantation. A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken, and intravitreal antibiotics (vancomycin 1 mg/0.1ml and ceftazidime 2 mg/0.1ml) were administered twice (every 72 h), and peribulbar injection of triamcinolone acetonide after four days of the second intravitreal injection. The vitreous culture was confirmed for Staphylococcus epidermidis. The endophthalmitis was resolved, and visual acuity improved from 6/20 to 12/20 on day 7 and 22/20 on day 38. This is the first successful medical resolution of Staphylococcus epidermidis endophthalmitis post ICL surgery without ICL explantation and vitrectomy in the V4c model.Conclusions and importance: In antibiotic therapy, the excellent compliance and close follow-up of this endophthalmitis patient enabled careful postoperative surveillance on the effect of antibiotic therapy, avoiding the removal of the ICL or the loss of the integrity of the eye. The risk of potential infectious endophthalmitis post-ICL surgery should be fully emphasized during preoperative counseling.

Anterior segment structure changes caused by different luminance light after implantable collamer lens surgery

BackgroundsTo investigate the changes of anterior eye segment with implantable collamer lens (ICL) under mesopic and photopic conditions.MethodForty-seven eyes of myopic patients who underwent ICL V4c implantation were included. Three months after surgery, the pupil diameter (PD), dynamic vault, ACD (distance from the posterior corneal surface to the anterior lens surface), ACD-ICL (distance from the posterior corneal surface to the anterior ICL surface), and anterior chamber angle parameters were measured using the anterior segment optical coherence tomography (AS-OCT, Carl Zeiss AG, Germany) under completely mesopic (0 lx) and photopic (5290 lx) lighting conditions.ResultsCompared with mesopic conditions, a significant decreased vault was detected in photopic conditions (486.7 ± 186.1 μm versus 643.5 ± 191.2 μm, p < 0.001), while the ACD-ICL increased significantly (2.54 ± 0.24 mm versus 2.37 ± 0.23 mm, p < 0.001). The pupil was smaller in photopic condition (2.66 ± 0.23 mm versus 5.62 ± 0.55 mm, p < 0.001). ACD didn’t change(3.32 ± 0.24 mm versus 3.31 ± 0.22 mm, p = 0.079). The change of the vault was positively related to the changes of the PD (r2 = 0.301, p = 0.04). There were no statistical difference between the change of vault and the change of ACD-ICL (158.0 ± 58.1 μm versus 165.9 ± 65.3 μm, p = 0.320).ConclusionWhen exposed to high intensity light after ICL surgery, the pupil constricted, vault decreased, ACA widened and ACD-ICL increased. All these changes were caused by the change of iris not the crystalline lens.

Early pigment dispersion and raised intraocular pressure after uneventful central-hole implantable collamer lens surgery

Introduction: With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge. Patient and Clinical Findings: 2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments. Diagnosis, Intervention, and Outcomes: All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases. Conclusions: The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.

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.