J Korean Ophthalmol Soc.  2009 Jun;50(6):839-851. 10.3341/jkos.2009.50.6.839.

Clinical Outcomes of Toric Implantable Collamer Lens implantation

• Yoon JM
• Moon SJ
• Lee KH

• KMID: 2212360
• DOI: http://doi.org/10.3341/jkos.2009.50.6.839

Abstract

PURPOSE: To assess the efficacy of the Toric Implantable Collamer Lens (Toric ICL) to treat moderate to high myopic astigmatism.
METHODS
Toric ICL was implanted in 77 eyes of 40 patients with myopia (spherical equivalent [SE] between 3.5 and 18.5 diopters [D]) and astigmatism between 1 and 6 D. The patients were followed up for at least 3 months. Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, and postoperative complications were evaluated.
RESULTS
At 3months postoperatively, the proportion of eyes with 1.0 or better UCVA (56 eyes out of 77 eyes, 72.7%) was significantly greater than the proportion of eyes with preoperative 1.0 or better BSCVA (38 eyes out of 77 eyes, 49.4%). The mean manifest refractive cylinder dropped from 2.78D (+/-1.05) at baseline to 0.35D (+/-0.34) postoperatively, an 87.4% decrease in astigmatism. Mean manifest refraction SE (MRSE) improved from -9.93D (+/-2.66) preoperatively to 0.15D (+/-0.33) postoperatively. A total of 96.1% of eyes were predicted accurately to within +/-0.75D of predicted MRSE. Mean improvement in BSCVA was 0.79lines; there were no eyes that lost two lines of BSCVA after 3 months postoperatively.
CONCLUSIONS
The results support the efficacy and predictability of Toric ICL implantation to treat moderate to high myopic astigmatism.

Keyword

Myopic astigmatism; Toric ICL; Toric Implantable Collamer Lens

MeSH Terms

Astigmatism
Eye
Humans
Myopia
Postoperative Complications
Visual Acuity

Figure

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  Figure 1. Preoperative (pre-op) best spectacle-corrected visual acuity (BSCVA) versus 3-month postoperative uncorrected visual acuity (UCVA) for the Toric Implantable Collamer Lens cohort.

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  Figure 2. Preoperative (pre-op) versus 3-month post-operative refractive cylinder for the Toric Implantable Collamer Lens cohort (D=diopters; MR=manifest refraction).

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  Figure 3. Attempted vs achieved spherical equivalent The difference between achieved spherical equivalent and attempted spherical equivalent is within 1diopter in most cases.

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  Figure 4. (A) Preoperative astigmatism. The yellow dots show preoperative astigmatism which consist of axis and diopter in the double angle scatter plot. It is scattered and the average of astigmatism is −2.75 diopter with 30.9° (B) 3-month postoperative astigmatism The yellow dots show postoperative astigmatism which consists of axis and diopter in the double angle scatter plot. It is not scattered but focused on zero point and the average of astigmatism is −0.35 diopter with 24.9°

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  Figure 5. The amount of corrected astigmatism in each patient. In most of the patients, astigmatism decreased by about 86%.

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  Figure 6. Spherical equivalent (MRSE=manifest refraction spherical equivalent).

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  Figure 7. Best spectacle corrected visual acuity.

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  Figure 8. Preoperative (pre-op) versus 3-month post-operative best spectacle-corrected visual acuity (BSCVA) for the Toric Implantable Collamer Lens cohort.

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  Figure 9. BSCVA line changes Preoperative versus 3-month postoperative line change in best spectacle-corrected visual acuity (BSCVA) for the Toric Implantable Collamer Lens cohort.

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  Figure 10. Scheimpflug photographs shows rotation of ICL. (A) First attack of rotation, postoperative 130 days. The rotation is about 45° clockwise from the initial position. (B) Second attack of rotation, postoperative 60 days after correction. The rotation is about the same as in the first attack.

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  Figure 11. Time sequence displacement of Toric ICL during surgical procedure that have rotational problem after surgery. (A) Axis alignment. (B) 5°clockwise rotation from the axis marker. (C) Correction of the misalignment by Vukich ICL manipulator during surgery. (D) At the end of the surgery, there was still 5° clockwise tilting even after repeated axis alignment.

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  Figure 12. Four forms of vaulting as visualized with the Scheimpflug camera. (A) No central vaulting and no peripheral vaulting. (B) Low central vaulting and no peripheral vaulting. (C) Moderate central vaulting and partial/asymmetrical peripheral vaulting. (D) Marked central vaulting and complete peripheral vaulting.

Reference

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