Toric Implantable Collamer Lens Research Articles

Rotational Stability after Toric Implantable Collamer Lens Implantation

Purpose: To evaluate rotational stability of Toric Implantable Collamer Lens (ICL) implantation to correct myopic astigmatism. Methods: We estimated the degree of Toric ICL rotation together with change in visual acuity and astigmatism in 118 eyes of 66 patients who underwent Toric ICL implantation and had a long-term mean follow-up period of 37 months. Results: After Toric ICL implantation, 107 (91%) out of 118 eyes showed uncorrected visual acuity of 0.8 or better. The mean postoperative astigmatism decreased to -0.64 ± 0.61 D from a mean preoperative astigmatism of -2.96 ± 1.13 D. The mean axis change of Toric ICL was 2.4 ± 3.8 degrees during follow-up period. Two (1.7%) out of 118 eyes showed the axis change of more than 10 degrees. These two eyes had a decrease in visual acuity, rotational axis change of 18 degrees and 30 degrees, respectively, and increases in astigmatism of 1.50 D and 1.00 D, respectively. The remaining 116 eyes (98.3%) showed excellent rotational stability without visual acuity decreasing Toric ICL rotation during the follow-up period. Conclusions: Toric ICL implantation to correct high myopia with astigmatism rarely has axis rotation and maintains excellent rotational stability for long-term follow-up. J Korean Ophthalmol Soc 2015;56(4):477-484

Sudden Loss of Endothelial Cell Density 7 Years after Receiving an Implantable Contact Lens: A Case Report

Purpose: To report a case of decreased endothelial cell density 7 years after posterior chamber phakic intraocular lens implantation. Case summary: A 45-year-old man with high myopia combined with astigmatism was treated with Toric implantable Collamer Lens (ICL) implantation. The patient’s best corrected visual acuity was 0.7 in both eyes before the operation. After the treatment, his uncorrected visual acuity was 0.9 and corrected visual acuity was 1.0 in both eyes, indicating an improvement in visual function. Preoperative endothelial cell density measured 3,063 cells/mm in the right eye and 3,126 cells/mm in the left eye. At 5 years postoperatively, measurements were 2,897 cells/mm in the right eye and 2,974 cells/mm in the left, showing little change. However, a 6-year postoperative measurement of 2,198 cells/mm in the right eye and 2,803 cells/mm in the left showed a slight decrease in endothelial cell density in the right eye, and a follow-up measurement one year later displayed a rapid decline to 1,272 cells/mm in the right eye and 2,852 cells/mm in the left eye. The Toric ICL lens was removed from the right eye and phacoemulsification and posterior chamber intraocular lens implantation was performed. Two-month postoperative endothelial cell density was 1,257 cells/mm and endothelial cell damage from the operation itself was minimal. Conclusions: ICL implantation may cause complications related to corneal endothelial cells as well as glaucoma. Patients should receive regular follow-up examinations for endothelial cell density. J Korean Ophthalmol Soc 2015;56(5):784-788

Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up.

Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months. Results. At baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, only K (steep) and K (max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, P < 0.001) and mean corrected distance visual acuity (0.17 ± 0.08 to 0.11 ± 0.05 logMAR, P < 0.001) at 12 months after ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes. Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years.

Current concepts and future developments of corneal cross-linking.

The introduction of corneal cross-linking (CXL) has changed the landscape of treatment and management of keratoconus and ectasia after refractive surgery. Previously, treatment options provided only temporary visual rehabilitation without limiting disease progression. Keratoconus and ectasia resulted in significant vision-related reduction in quality of life and a substantial lifetime economic burden, with up to 20% of keratoconus cases resulting in eventual corneal transplantation [1]. CXL was introduced as the first therapeutic option for keratoconus aimed at stiffening the cornea in order to treat the underlying stromal instability. From the time that the first reports of the clinical application of cross-linking in the cornea were published in 2003 [2], CXL has rapidly been adopted as a standard therapy for treatment of progressive keratoconus in much of the world [3–5]. The potential for early intervention with corneal cross-linking before visual function has been compromised has resulted in a shift in the way we think about corneal biomechanics and has reawakened interest in the early diagnosis of ectasia. In this issue, J. Steinberg et al. report two new parameters to detect biomechanical changes in the keratoconic cornea after CXL using in vivo corneal visualization Scheimpflug technology. Research in the area of corneal biomechanics has the potential to enable earlier diagnosis of patients in need of CXL and better analysis of the effects of the procedure. While many questions remain unanswered, the understanding of the photochemical mechanisms that result in the formation of cross-links in the cornea has grown exponentially in the last decade. Improved scientific understanding of the mechanisms of CXL has driven clinical research aimed at optimizing CXL for better efficiency and efficacy [6]. In this issue, A. C. da Paz et al. present a critical review of known and as yet undetermined effects of CXL on corneal structure, biomechanics, and functional aspects. J. Antoun et al. examine patient characteristics that contribute to cross-linking failure to stabilize keratometry and examine the effect of repeat treatments on eyes that have continued to progress after primary CXL. The remaining contributions to the special issue explore modifications to the conventional protocol that incorporate new technology, such as transepithelial riboflavin formulations designed to improve patient comfort (S. Taneri et al.) and higher irradiance and pulsed UVA delivery aimed at improving procedure speed and photon efficiency (C. Mazzotta et al.). CXL combination procedures targeted at maximizing visual outcomes through the addition of simultaneous intracorneal ring implantation (P. Studeny et al.) or subsequent phakic toric implantable collamer lens insertion (R. Antonios et al.) are also discussed. Together, the papers in this special issue describe the next generation of corneal cross-linking. The contributors explore the potential to maximize CXL efficacy, provide equivalent or greater treatment effect in shorter total treatment times, reduce patient discomfort and speed visual recovery, and offer both stabilization and functional visual improvement through CXL combination procedures. Suphi Taneri Elias Jarade John A. Kanellopoulos David Muller

Three-year follow-up of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus

AimTo assess the clinical outcomes following the use of toric implantable collamer lenses (toric ICL, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus.MethodsThis retrospective study evaluated 21...

Collagen copolymer toric phakic intraocular lens for myopic astigmatism: One-year follow-up

To assess the predictability, stability, safety, and efficacy of a collagen copolymer toric phakic intraocular lens (pIOL) to correct moderate and high astigmatism. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Case series. After implantation of the TV4b toric Implantable Collamer Lens pIOL, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, toric pIOL vault, and adverse effects were evaluated over 12 months. The study enrolled 35 eyes of 20 patients with a mean sphere of -5.46 diopters (D) ± 4.17 (SD) and mean cylinder of -3.14 ± 1.19 D. At 12 months, the mean sphere was -0.04 ± 0.16 D, with 97% of eyes being within ±0.50 D of the target (r(2) = 0.99), and the mean cylinder was -0.29 ± 0.42 D. For the astigmatism components, 80% of eyes were within ±0.25 D of both J0 (r(2) = 0.99) and J45 (r(2) = 0.99). The mean decimal UDVA was 0.89 ± 0.16 and the mean decimal CDVA, 0.95 ± 0.12. No eye lost lines of CDVA, and 43% of eyes gained 1 or more lines. The safety index was 1.08 at 12 months. More than 50% of eyes had a Snellen UDVA of 20/20. The efficacy index was 0.97 at 3 months and 1.01 at 12 months. The visual and refractive outcomes were good and highly stable throughout the follow-up, indicating that this toric pIOL model is predictable, safe, and effective in correcting low and high levels of astigmatism. No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of a Toric Implantable Collamer Lens After Corneal Collagen Crosslinking in Treatment of Early-Stage Keratoconus

The aim of this study was to assess the predictability, efficacy, safety, and stability in patients who received a toric implantable collamer lens (TICL) after collagen crosslinking in early-stage keratoconus. This prospective interventional case series study was conducted at the Alexandria Main University hospitals, University of Alexandria, Egypt. Sixteen eyes underwent implantation of a TICL (STAAR Surgical Inc) after crosslinking. The mean spherical refraction was -5.98 ± 4.39 diopters (D) (range, -0.50 to -14.50 D), and the mean cylinder was -4.91 ± 1.51 D (range, -2.50 to -7.75 D). Uncorrected distance visual acuity (UDVA), manifest and cycloplegic refraction, corrected distance visual acuity (CDVA), vault, intraocular pressure, and endothelial cell count (using specular microscopy) were evaluated during a 3-year follow-up. The mean Snellen decimal CDVA improved from 0.56 ± 0.13 (range, 0.40-0.80) preoperatively to 0.89 ± 0.17 (range, 0.60-1.20) at 3 years of the follow-up (P < 0.0001). The mean UDVA also improved significantly from 0.63 ± 0.14 before ICL implantation to 0.88 ± 0.18 after 3 years of the follow-up (P < 0.001). At 3 years, the mean spherical and cylindrical manifest refractions were 0.00 ± 0.18 D and -0.05 ± 0.14 D, respectively. At the end of the follow-up, the vault was 509.75 ± 141.47 μm (range, 320-900) and the intraocular pressure was 11.94 ± 1.12 mm Hg. No complications occurred during the surgical procedures. No eye needed explantation or repositioning of the TICL. The endothelial cell count loss after 3 years was -8.98%. Correction of spherical and cylindrical refractive errors in keratoconic eyes by TICL implantation 12 months after crosslinking gave significantly promising outcomes, particularly in the astigmatic component of refraction.

Visian Toric ICL Implantation after Intracorneal Ring Segments Implantation and Corneal Collagen Crosslinking in Keratoconus

To evaluate the safety and clinical outcome of Visian toric implantable collamer lens (TICL) implantation for the treatment of residual refractive errors 6 months after sequential intracorneal ring segments (ICRS) and corneal collagen UVA crosslinking (CXL) in stable keratoconus. This retrospective study examined the results of a 3-step ICRS-CXL-TICL in 11 eyes of 7 patients with moderate to severe keratoconus. The 2 procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and TICL implantation was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after TICL implantation. The ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity, and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 45.19 ± 3.98 D vs 48.51 ± 4.26 D preoperatively (p = 0.022) and mean Ksteep was 50.41 ± 4.32 D vs 54.24 ± 4.96 D preoperatively (p = 0.032). Uncorrected distance visual acuity (UCVA) significantly improved from 1.47 ± 0.38 logMAR before ICRS-CXL to 0.27 ± 0.20 logMAR 6 months after (p = 0.002). Corrected distance visual acuity (CDVA) significantly improved from 0.50 ± 0.22 logMAR to 0.29 ± 0.23 logMAR (p = 0.001). At 6 months post TICL implantation, UCVA improved significantly to 0.27 ± 0.20 logMAR and the CDVA was 0.19 ± 0.11 logMAR. No intraoperative or postoperative complications occurred. Toric ICL implantation after sequential ICRS implantation and CXL is an effective and safe option for correcting high residual refractive error and improving visual acuity in patients with moderate to severe keratoconus.

Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to −24 diopters (D) and 0 to −6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was −10.35 ± 5.1 D (+8 to −24) and the postoperative sphere was −0.09 ± 1.06 D (+3.25 to −6.5), p < 0.001. Preoperative cylinder was −2.63 ± 1.44 (0 to −6.5 D) and postoperative cylinder was −0.97 ± 0.89 D (0 to −3.5), p < 0.001. The preoperative mean spherical equivalent was −11.6 ± 5.12 D (+7.875 to −25.625) and postoperative spherical equivalent was −0.52 ± 1.03 (+2.25 to −6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.

Stability of axis and patient satisfaction after toric implantablecollamer lens implantation for myopic astigmatism

To assess the stability of axis and patient satisfaction after toric visian implantable collamer lens (TICL) implantation for moderate to high myopic astigmatism. Total 33 eyes of 21 consecutive patients who underwent implantation of TICL for the correction of moderate to high myopic astigmatism were recorded and a minimum follow-up of six months was performed. The deviation of axis of TICL was detected from one week to six months postoperatively. The evaluation of the visual functions was done by the same clinician at six months after surgery. The mean refractive cylinder decreased from -2.48±0.91 diopters (D) preoperatively to -0.54±0.25D and -0.50±0.19D at one week and six months after surgery respectively. Mean changes in astigmatism from one week to six months after surgery was 0.03±0.17D. The mean deviation of axis of TICL from one week to six months postoperatively was 2.48±1.25°(range,1°~ 6°) and no TICL required secondary repositioning. 14.3% patients felt difficult about the middle distant visual function (Reading Computer Screen). Evaluations of other visual functions were positive or very positive. Conclusions : Six months after implantation of the TICL, it showed slightly axis rotation and high satisfaction about the visual functions.

Clinical research on toric implantable collamer lens for patients with high myopic astigmatism

Clinical research on toric implantable collamer lens for patients with high myopic astigmatism

Posterior Chamber Toric Phakic IOL Implantation for the Management of Pediatric Anisometropic Amblyopia

To report the outcomes of toric posterior chamber phakic intraocular lens (PIOL) implantation in children for the treatment of amblyopia due to anisometropia with astigmatism. Six eyes of 6 amblyopic patients aged 5 to 15 years underwent toric PIOL (Visian Toric ICL; STAAR Surgical Company, Monrovia, CA) implantation for refractory anisometropic amblyopia. Preoperative and postoperative clinical evaluation included slit-lamp microscopy, visual acuity, anterior/posterior segment examination, and cycloplegic refraction. After a mean follow-up of 23 months (range: 15 to 34 months), mean spherical equivalent cycloplegic refraction improved from -10.21 ± 4.62 diopters (D) (range -7.5 to -19.5 D) preoperatively to -0.42 ± 0.39 D (range: -0.625 to +0.125 D) postoperatively. Corrected distance visual acuity ranged from 20/40 to 20/200 preoperatively and 20/20 to 20/60 postoperatively. Five of the 6 eyes gained more than 3 lines of corrected distance visual acuity with a maximum gain of 8 lines in one eye. One eye showed an improvement of more than 2 lines (change in preoperative visual acuity of 20/100 to 20/60 postoperatively). No patients lost any lines of visual acuity. All eyes remained quiet. All PIOLs remained well centered throughout the follow-up period. Toric PIOL implantation may be a viable therapeutic modality in children with clinically significant anisometropic ametropia and astigmatism with secondary amblyopia who have been refractory to medical treatment including spectacles or contact lenses. Longer follow-up visits with larger sample populations will evaluate more effectively the long-term efficacy and late-onset of complications.

Anterior segment variations after posterior chamber phakic intraocular lens implantation in myopic eyes

To evaluate anterior segment variations after posterior chamber phakic intraocular lens (pIOL) implantation in myopic eyes. Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Cohort study. Patients with high myopia were scheduled for nontoric Implantable Collamer Lens pIOL or toric Implantable Collamer Lens pIOL implantation. Anterior segment optical coherence tomography was performed to evaluate the anterior segment variations over time and the impact of physiologic accommodation and change in brightness after pIOL implantation. Slitlamp photography of the anterior segment was taken after pupil dilation to calculate pIOL rotation. There was significantly improved visual acuity and refractive status after implantation of both pIOLs. Anterior segment axial variations had good stability 6 months postoperatively. However, nontoric pIOL rotation occurred in 1 eye 7 months postoperatively and rotation of the toric pIOL occurred in 2 eyes at 3 months and 6 months. Stimulations of -4.0 diopters (D) and -8.0 D led to significant changes in anterior chamber depth (ACD) based on the lens (ACD-lens), ACD after pIOL implantation, distance between the pIOL posterior surface and the lens anterior surface (pIOL-lens), and pupil diameter. Increasing ambient light brightness could reduce the ACD-lens and pIOL-lens. Both pIOLs had good axial stability in myopic eyes 6 months postoperatively; however, rotational stability over time could not be determined. The physiologic adjustment and change in brightness could influence the anterior segment significantly in eyes with a pIOL.

Toric implantable collamer lens for high myopic astigmatism in keratoconic patients after six months

BackgroundThe aim was to evaluate the safety, efficacy, stability and predictability of posterior chamber collagen copolymer phakic intraocular lens (pIOL) implantation to correct myopia and myopic astigmatism associated with keratoconus.MethodsThe unaided vision and visual acuity, refraction and adverse events were measured in 22 keratoconic eyes of 14 patients after using an implantable collamer lens (ICL) (STAAR Surgical Inc.) to correct refractive error. The outcome was evaluated over six months.ResultsThe mean pre‐operative spherical equivalent (SE) and cylinder changed from ‐4.98 ± 2.63 DS and ‐2.77 ± 0.99 DC to ‐0.33 ± 0.51 DS and ‐1.23 ± 0.65 DC, respectively at the end of six months. Before the surgery the mean Snellen decimal visual acuity was 0.63 ± 0.20. The mean unaided vision and visual acuity changed to 0.76 ± 0.23 and 0.85 ± 0.21, respectively at the end of six months. The mean safety and efficacy indices were 1.40 ± 0.32 and 1.24 ± 0.34, respectively. No eye lost a line of visual acuity and 17 eyes (77.3 per cent) gained one or more lines. Fifteen eyes (68.2 per cent) were within 0.50 D and 20 (90.9 per cent) were within 1.00 D of the desired spherical equivalent refraction. There was a change in manifest refraction of 0.09 ± 0.21 (ranging from ‐0.25 to +0.75) from one week to six months after the surgery.ConclusionThe clinical outcomes of the current study demonstrate the safety, efficacy and predictability of toric implantable collamer lens in the correction of myopia and myopic astigmatism associated with keratoconus. The patients' refractions achieved early stability and remained stable during the course of the study.

Three-Year Follow-Up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

PurposeTo assess the 3-year clinical outcomes of toric phakic intraocular lens (Visian ICL™; STAAR Surgical) implantation for moderate to high myopic astigmatism.MethodsThis retrospective study evaluated fifty eyes of 28 patients who underwent toric ICL implantation for the correction of moderate to high myopic astigmatism and who regularly returned for postoperative examination. Before, and 1, 3, and 6 months after, and 1, 2, and 3 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery in eyes undergoing toric ICL implantation.ResultsThe logarithm of the minimal angle of resolution (LogMAR) uncorrected visual acuity and LogMAR best spectacle-corrected visual acuity were –0.10 (corresponding to Snellen equivalents 20/16) ± 0.16 and –0.20 (corresponding to 20/12.5) ± 0.07, 3 years postoperatively, respectively. The safety and efficacy indices were 1.16 ± 0.20 and 0.94 ± 0.28. At 3 year, 82% and 98% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of –0.15 ± 0.31 D occurred from 1 month to 3 year. No vision-threatening complications occurred during the observation period.ConclusionsOn the basis of the clinical results of this study, toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopic astigmatism throughout a 3-year observation period.

Safety and Visual Outcome of Visian Toric ICL Implantation After Corneal Collagen Cross-linking in Keratoconus

To evaluate the safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. A retrospective study examined the results of the two-step CXL and Visian toric ICL implantation in 16 eyes of 10 patients with keratoconus. The two procedures were done at an interval of 6 months. Data were collected preoperatively, at the 6-month follow-up visit after CXL, and at the 6-month follow-up visit after ICL implantation. CXL induced a statistically significant decrease in steep keratometry (50.02 ± 4.07 at baseline to 48.74 ± 4.05 at 6 months after CXL, P = .001) without any significant change in visual acuity or refraction. At 6-month follow-up after ICL implantation, mean K (max) was 50.49 ± 4.07 versus 52.29 ± 4.79 D at baseline (P = .001). Mean uncorrected distance visual acuity improved from 1.67 ± 0.49 to 0.17 ± 0.06 logMAR (P = .001) and mean corrected distance visual acuity improved from 0.15 ± 0.06 to 0.12 ± 0.04 logMAR (P = .023). Mean spherical equivalent decreased from -7.24 ± 3.53 to -0.89 ± 0.76 D (P = .001) and mean cylinder decreased from 2.64 ± 1.28 to 1.16 ± 0.64 D (P = .001). The safety and efficacy indices were 1.08 ± 0.13 and 0.97 ± 0.08, respectively. No intraoperative or postoperative complications occurred. Implantation of the Visian toric ICL following CXL is an effective option for improving visual acuity in patients with keratoconus.

Myopic astigmatism correction: comparison of a Toric Implantable Collamer Lens and a bioptics technique by an adaptive optics visual simulator

To compare the optical and visual quality of a simulated Toric Implantable Collamer Lens (TICL) and a bioptics technique to treat high myopic astigmatism. An adaptive optics visual simulator was used to simulate the vision after TICL implantation and a bioptics procedure from the wavefront aberration pattern for moderate and high-myopic astigmatism. Visual acuity (VA) at different contrasts and contrast sensitivity (CS) at 10, 20 and 25 cycles degree(-1) were measured for 3 and 5-mm pupils. Modulation Transfer Function (MTF) and Point Spread Function (PSF) were calculated for a 5-mm pupil. At a 3-mm pupil we only found statistically significant differences in VA between the two simulated surgeries at low-contrast for moderate- and high-myopic astigmatism (p < 0.05). Statistically significant differences were found in CS at 3-mm pupil between both procedures at the highest spatial frequency for moderate-myopic astigmatism and at all frequencies for high-myopic astigmatism (p < 0.05). At a 5-mm pupil we found statistically significant differences in VA and CS between both simulated surgeries at all contrasts and frequencies evaluated for both groups (p < 0.05). In all cases VA and CS were better with the TICL than with the bioptics technique. MTFs for the bioptics technique were worse than those computed for the TICL. The TICL showed less spread out of the PSF than the bioptics procedure. Simulated TICL and bioptics procedures provided good optical and visual quality, although TICL implantation provided slightly better outcomes than the bioptics procedure, especially when the pupil diameter was increased.

Partial Visual Rehabilitation Using a Toric Implantable Collamer Lens in a Patient with Keratoconus: A Case Report with 20 Months of Follow-up

We report the case of a 37-year-old man with a high myopic keratoconus eye that was treated with a posterior chamber toric implantable collamer lens (ICL) in Korea. The patient had a history of contact lens intolerance and did not want to have a corneal transplantation. His uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity were 0.02 and 0.4 in the left eye, respectively. Preoperatively, the manifest refraction was -12.0 -3.5 × 30A. Postoperatively, the manifest refraction was -1.75 × 180A. UCVA improved markedly after implantation. No intraoperative or postoperative complications were observed during 20 months of follow-up. Toric ICL implantation may be a possible alternative surgical option for the visual rehabilitation of high myopic astigmatism in keratoconus patients with rigid gas permeable contact lens intolerance and in patients who do not want to get a corneal transplant.

Correction of Postkeratoplasty Ametropia in Keratoconus Patients Using a Toric Implantable Collamer Lens

To evaluate the efficacy and safety of a toric implantable Collamer lens (Visian TICL®) for correction of high postkeratoplasty ametropia in patients with keratoconus. Seven eyes of 7 keratoconus patients postkeratoplasty (5 M, 2 F; mean age 34.1±5.9 years, range 28-44) unable to wear glasses or contact lenses were included in the study. A foldable phakic posterior chamber Collamer toric lens was injected through a standard 3.0-mm clear corneal temporal incision. Uncorrected distance visual acuity (UCDVA, logMAR), best-corrected distance visual acuity (BCDVA, logMAR), spherical refraction, cylindrical refraction, and refractive spherical equivalent (RSE) were measured preoperatively and postoperatively. Postoperative adverse events were recorded. . The mean follow-up was 12.8±8.8 months (range 4-30). A significant (p<0.01) improvement was observed postoperatively in mean UCDVA (1.18±0.4 vs 0.2±0.1), spherical refraction (-5.89±3.43 vs 0.53±0.75), cylindrical refraction (-4.39±0.75 vs -1.74±0.84), and RSE (-8.09±3.77 vs -0.33±0.54). The BCDVA changes were not significant (0.09±0.11 vs 0.05±0.08). All patients gained ≥5 lines of UCDVA (average 7.6±1.9 lines). The number of patients with UCDVA ≥6/12 (0.3 logMAR) increased after surgery (0% vs 87.5%; p<0.01), while the number of patients with BCDVA ≥6/12 was unchanged (100% vs 100%; NS), with 0% (0/7) of patients losing ≥2 BCDVA lines. No complications were observed postoperatively. Toric implantable Collamer lens was safe and effective in correcting postkeratoplasty myopia and astigmatism in keratoconus patients.

Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up

To evaluate the 3-year clinical outcomes after toric implantable collamer lens (ICL) implantation for the management of moderate to high myopic astigmatism. Thirty-four eyes of 20 patients who underwent toric ICL implantation were reviewed. All eyes completed 3-year follow-up. Uncorrected (UDVA) and corrected (CDVA) distance LogMAR visual acuities, refraction, endothelial cell density (ECD), and surgical complications were evaluated. Vectorial analysis of astigmatic correction was also done. A significant improvement in UDVA, CDVA, manifest spherical and cylindrical refraction was observed at 1 week and remained stable after 3 years. Twenty-six eyes (76.5%) gained lines of CDVA, and two eyes (5.9%) showed a loss of 1 line of CDVA. The spherical equivalent (SE) was within ±0.50 D of emmetropia in 18 eyes (52.9%) and within ±1.00 D in 28 eyes (82.4%). Differences between target-induced astigmatism (TIA) and surgically-induced astigmatism (SIA) were statistically significant (p < 0.01), and a trend to undercorrection of the refractive astigmatism was present after 3 years. The magnitude of flattening effect (FE) was found to be significantly lower than the magnitude of TIA (p < 0.01). The magnitude of the torque vector was always positive, with a value below 0.50 D in all cases. No vision-threatening complications were observed during the follow-up. Toric ICL implantation is an effective and safe surgical option that provides a relatively predictable and stable refractive correction of myopic astigmatism. Further improvements are needed to minimize the degree of undercorrection.