PurposeTo compare the presbyopia-correcting performance, visual quality, satisfaction and life quality after implantation of a diffractive trifocal intraocular lens (IOL) in eyes with different axial lengths (AL).MethodsThis prospective cohort study enrolled patients with implantation of a trifocal IOL. Manifest refraction, uncorrected and distance-corrected visual acuity at different distances, contrast sensitivity, aberrations and IOL decentration were measured 3 months after surgery. Spectacle independence, adverse photic phenomena, overall satisfaction and life quality were assessed with a questionnaire.ResultsThis study included 61 eyes of 61 patients: 16 eyes in the short AL group, 28 eyes in the control group and 17 eyes in the long AL group. Postoperatively, the prediction error (PE) of spherical equivalent showed a difference (P = 0.002). The uncorrected near visual acuity in the long AL group was higher (P = 0.047). Although a higher IOL decentration was obtained in the long AL group (P = 0.034), no significant difference was found in contrast sensitivity and aberrations (all P > 0.05). In the questionnaire, patients in the long AL group showed a relatively lower spectacle independence at near distance (P = 0.060) and had difficulties in near activities, mental health and role in daily life (P = 0.003, 0.021, and 0.033). However, no significant difference was observed in overall satisfaction (P = 0.124).ConclusionWith detailed preoperative evaluation, the trifocal IOL provided satisfactory visual outcomes for patients with different AL. AL had a certain influence on predictability and IOL decentration. And for patients with long AL, the inadaptability to the near focal point might become an important problem.
Purpose: To evaluate the performance of different nomograms and vault prediction formulas in predicting the optimal Implantable Collamer Lens (ICL; STAAR Surgical) size and vault. Methods: This retrospective study included 108 participants (214 eyes) who underwent ICL implantation. The efficacy of the manufacturer's nomogram, Parkhurst nomogram, NK formula, KS formula, Zhu formula, and ZZ formula was assessed by comparing the indicated ICL sizes to the postoperative vault measurements. Additionally, Bland-Altman plots and the Friedman test were used to assess the agreement and absolute error between the actual vault and predicted vault. Results: The proportions of the ideal ICL category recommended by the manufacturer's nomogram, Parkhurst nomogram, NK formula, KS formula, Zhu formula, and ZZ formula were 50.5%, 45.3%, 46.7%, 42.5%, 50.0%, and 28.5%, respectively. The mean differences between the actual vault and the predicted vault using the NK, KS, Zhu, and ZZ formulas were 144.1 ± 261.1, −19.3 ± 179.6, 70.8 ± 284.2, and 182.6 ± 361.5 μm, respectively. The predicted ICL vault tended to overestimate the actual ICL vault, particularly when choosing a larger ICL size. The KS formula shows the smallest deviation in prediction error and is least affected by variation in ICL size. Conclusions: White-to-white distance from the Pentacam (Oculus Optikgeräte GmbH) coupled with the manufacturer's nomogram performed well for ICL size selection. Four vault prediction formulas tended to overestimate the actual ICL vault, particularly when selecting a larger ICL size. The KS formula appeared to have the least bias of the formulas. Simultaneously, vault prediction formulas need to be modified according to the ICL size. [ J Refract Surg . 2023;39(7):456–461.]
Background To evaluate anterior segment structural alterations after implantable collamer lens (ICL) implantation in myopic patients using swept-source quantitative optical coherence tomography (SS-OCT). Methods This prospective study included 47 eyes in 24 patients with preoperative spherical equivalent ≥ -3.00 D. Patients underwent ICL implantation at Department of Ophthalmology, Peking University Third Hospital, from May 2021 to December 2022. SS-OCT was used to measure anterior chamber width (ACW), angle opening distance (AOD), angle recess area (ARA), trabecular-iris area (TISA), trabecular-iris angle (TIA), iridotrabecular contact (ITC) area, and ITC Index before ICL implantation surgery and at 1 month follow-up. The correlations among the ITC index, vault, and angle parameters were analysed. Receiver operating characteristic (ROC) analysis was used to explore the ability of the vault to identify eyes with suspected angle-closure. Results At one month following ICL implantation, the ITC area was 0.396 ± 0.37 mm2, and the ITC index is 8.143 ± 5.439%. All angle parameters, except ACW, showed a statistically significant reduction on SS-OCT (P < 0.05). Mean AOD500, AOD750, ARA500, ARA750, TISA500, TISA750, TIA500, and TIA750 values at one month postoperatively decreased by 60.0%, 60.4%, 58.1%, 59.2%, 57.3%, 58.7%, 48.8%, and 50.7%, respectively. The vault was positively correlated with the ITC index and percent change in anterior chamber angle parameters. A vault of > 0.659 mm was found to be optimal for angle-closure suspect with a sensitivity of 85.2% and a specificity of 53.9%. Conclusions Anterior chamber angle parameters decreased one month after ICL implantation, and their percentage changes and ITC index correlated with the vault. When the vault is larger than 0.659 mm, it is necessary to be alert to possible closed angle suspicion.
Purpose. To evaluate the anterior segment structure alteration after implantable collamer lens (ICL) implantation in myopic patients using swept-source quantitative optical coherence tomography (SS-OCT). Methods. This prospective study included 47 eyes of 24 patients with preoperative spherical equivalent ≥ -3.00 D. Patients underwent ICL implantation at Department of Ophthalmology, Peking University Third Hospital, from May 2021 to December 2022. SS-OCT was used to measure biometry including anterior chamber width (ACW), angle opening distance (AOD), angle recess area (ARA), trabecular iris area (TISA), trabecular-iris angle (TIA), iridotrabecular contact (ITC) area and ITC Index before ICL implantation surgery and at 1 month follow-up. Results. At one month following ICL implantation, the ITC area is 0.396 ± 0.37 mm2, and the ITC index is 8.143 ± 5.439 %. All angle parameters, with the exception of ACW, showed a statistically significant reduction on SS-OCT (P<0.05). Mean AOD500, AOD750, ARA500, ARA750, TISA500, TISA750, TIA500 and TIA750 values at one month postoperatively declined by 60.0%, 60.4%, 58.1%, 59.2%, 57.3%, 58.7%, 48.8% and 50.7%, respectively. Vault was positively correlated with ITC index and the percent change in anterior chamber parameters. The vault of >0.659mm was found to be optimal for angle-closure suspect with a sensitivity of 85.2% and a specificity of 53.9%. Conclusions. Anterior chamber parameters decreased 1 month after ICL implantation, and their percentage changes and ITC index correlated with the vault. When the vault is larger than 0.659mm, it is necessary to be alert to possible closed angle suspicion.
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