Eight-Year Outcomes of Implantation of Posterior Chamber Phakic Intraocular Lens With a Central Port for Moderate to High Ametropia

Abstract

Purpose: To assess the 8-year clinical outcomes of implantation of an implantable collamer lens (ICL) with a central port (KS-Aquaport; EVO-ICL) for moderate to high myopia and myopic astigmatism.Methods: This retrospective study comprised a total of 177 eyes of 106 patients with spherical equivalents of −7.99 ± 3.33 D [mean ± standard deviation], who underwent EVO-ICL implantation. We evaluated the safety, efficacy, predictability, stability, and adverse events of the surgery, at 1 month, and 1, 2, 4, 6, and 8 years postoperatively.Results: The logarithm of the minimal angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were −0.07 ± 0.17 and −0.20 ± 0.09, respectively, at 8 years postoperatively. The safety and efficacy indices were 1.18 ± 0.24 and 0.89 ± 0.28, respectively. At 8 years, 83 and 93% eyes were within ± 0.5 D and ± 1.0 D of the targeted correction, respectively. Change in manifest refraction from 1 month to 8 years postoperatively was −0.13 ± 0.30 D. Three eyes (1.7%) that developed cataracts had a slight pre-existing peripheral anterior subcapsular cataract formation required simultaneous ICL extraction and cataract surgery at 2 or 3 years or ICL size change (1 size up) at 7 years postoperatively. We found that neither significant intraocular pressure (IOP) rise (including pupillary block) nor significant endothelial cell loss occurred in any case throughout the 8-year observation period.Conclusions: Current ICL implantation with central port technology offered good continuous outcomes for all measures of safety, efficacy, predictability, and stability for correcting moderate to high myopic errors over a long period, thereby suggesting its long-term viability as a surgical approach for the treatment of such eyes.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

“…Cataract is one of the common complications after ICL implantation [161], and early cataract after ICL implantation is mostly related to surgical trauma, while late cataract is mostly related to contact between ICL and the lens itself [162]. The incidence increases with the passage of postoperative time [68,74,77,84,142,[163][164][165][166][167][168][169]. It has been reported that the incidence of cataract within 10 years after ICL implantation is 12.1% [78] and the risk of cataract formation will increase seven years after ICL implantation [114].…”

Vertically Fixated Posterior Chamber Phakic Intraocular Lens Implantation Through a Superior Corneal Incision

“…We described the details of the surgical procedures in our previous reports [4,[13][14][15][16]. In brief, on the day of surgery, dilating and topical anesthetic agents were applied.…”

“…The EVO Visian implantable collamer lens (EVO Visian ICL TM , STAAR Surgical, Monrovia, CA, USA), a posterior chamber phakic intraocular lens with central port technology, has been established as a long-term safe and effective means to correct moderate to high ametropia [1][2][3][4] and has also been shown to be more effective in reducing significant postoperative complications such as cataract formation than the conventional ICL without a central port [1][2][3][4][5], possibly resulting from the improved circulation of the aqueous humor to the anterior surface of the crystalline lens [6,7]. The ICL is generally fixated to the horizontal plane through a temporal corneal incision according to the manufacturer's recommendations.…”

Posterior chamber toric implantable collamer lenses vs LASIK for myopia and astigmatism: systematic review

“…Longer follow-up studies on ICL V4c report likewise reassuring results. 39,40 The older ICL models had a risk for pupillary block glaucoma mainly because of inadequate preoperative iridotomies and/or excessive ICL vaulting. 10 The V4c model eliminates the need of a YAG-iridotomy or iridectomy and is believed to reduce the risk for pupil block and thus angle closure by allowing sufficient aqueous flow through the central port.…”

“…Reduction in endothelial cell density after ICL V4c implantation was 2.4% at 5 years, 2.6% at 7 years, and 3.6 ± 7.0% at 8 years postoperatively, without significant endothelial cell density loss (>20%) in all 3 articles. [37][38][39] On the other hand, publications on postoperative complications and adverse effects after LASIK surgery consisted of epithelial ingrowth (0.1% and 2.7%), dry eye disease (1.1%), post-LASIK keratectasia (0%), infectious keratitis (0.1%), diffuse lamellar keratitis (DLK) (2.1%), and corneal opacification (among which DLK) (0.9%). 5,32 Of interest, 1 follow-up study of 12 years (n = 68) reported a zero incidence of postoperative complications (epithelial ingrowth, DLK, severe dry eye, and keratectasia).…”