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ICL vault decreases, yields scant effect on visual outcome at 1 year postop
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Vaulting of a posterior chamber phakic IOL diminished over time and had an insignificant effect on vision 1 year postoperatively, a study found.
“It has been reported that eyes with lower vault (distance between the posterior surface of the ICL and the anterior surface of the crystalline lens) were a major risk for secondary cataract formation,” the study authors said. “Thus, vault is considered to be an important factor in relation to the safety of ICL implantation.”
The retrospective study included 127 eyes of 66 patients who received the Visian implantable Collamer lens (ICL, STAAR Surgical). Mean patient age was 28.66 years.
White-to-white diameter, central vault, refractive error and wavefront higher-order aberrations were evaluated preoperatively and up to 1 year postoperatively.
Study results showed that at 12 months, uncorrected visual acuity was 20/20 or better in 67% of eyes, 20/25 or better in 86.7% of eyes and 20/32 or better in 100% of eyes. UCVA equaled or exceeded preoperative best corrected visual acuity in 88.5% of patients.
Findings also included a significant decrease in vault up to 1 month; vault stabilized after 1 month. Data showed a statistically insignificant relationship between amount of vault and refractive error and a statistically significant association between vault and higher-order aberrations (P = .024).
Perspective
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Jorge L. Alió, MD, PhD
Phakic IOLs are becoming more and more an accepted standard in the correction of high refractive errors by many surgeons around the world. One of the popular models is the implantable Collamer retropupillar phakic IOL. In this paper, one of the concerns of the practical refractive surgeon, the mismatching of the phakic IOL size with the sulcus-to-sulcus distance causing excessive vaulting, is addressed. This paper demonstrates that changes in vault do not significantly influence the refractive outcome, and also that this vault is experiencing changes over the mid-term postoperative period, which indicates a better adaptation of the phakic IOL to the anatomy of the eye. This paper adds information to the practical surgeon about the fact that the precision in the correction obtained by a phakic IOL of this type is not influenced by the vault, even though this might affect the development of other complications, particularly the development of cataracts or damage to the iris pigmentary epithelium.
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Eur J Ophthalmol. 2012;22(2):153-160.
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