Implantable Collamer Lens Complications

Andrew Olivo-Payne MD, Guillermo Garcia-De la Rosa MD, Arturo Gomez-Bastar MD, Alejandro Navas MD, MSc, Arturo Ramirez-Miranda MD, Enrique Graue-Hernandez MD, MSc Instituto de Oftalmologia Fundacion Conde de Valenciana Mexico City, Mexico

Financial interests: AOP, GGD, AGB, EGH: None.ARM: Carl Zeiss Meditec (L), Thea Laboratories (S)AN: Alcon Laboratories (L), Carl Zeiss Meditec (C); STAAR Surgical Company (L)

Non-FDA approved medical devicesEmail: aolivo10@gmail.com

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Introduction

• Posterior chamber phakic intraocular lens (pIOL), effective for the correction of moderate to high ametropia

• The Visian implantable collamer lens (ICL; STAAR Surgical, Monrovia, CA)– Posterior chamber pIOL placed behind the iris

with the haptics resting on the ciliary sulcus

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Alfonso JF, Baamonde B, Fernández-Vega L, et al. Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia: five-year follow-up. J CataractRefractSurg. 2011

• The pIOL models have undergone improvements to minimize complications

• The newer V4c model is designed with a 0.36mm central hole to overcome acute pupillary block

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Alfonso JF, Baamonde B, Fernández-Vega L, et al. Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia: five-year follow-up. J CataractRefractSurg. 2011

Purpose

• To determine the incidence, etiology, risk factors and management of complications following implantation of phakic posterior chamber ICL V4 and its newer version ICL V4c.

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Patients and Methods

• Retrospective review • Consecutive clinical case series. • Inclusion:• Patients who underwent either spheric or

toric ICL implantation between +8 to -24 D sphere and 0 to -6.5 cylinder

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Results

• A total of 406 eyes were included, 349 ICL V4 and 57 ICL V4c model.

• 20 eyes presented complications (4.92%)• Mean follow-up of 47±31 months (3-127)– Myopic: n=204– Hyperopic: n=8– Toric: n=194

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Measurement Preoperative Postoperative p Value

Sphere (D) -10.35 ±5.1D -0.09±1.06 <0.001

Cylinder (D) -2.63±1.44 -0.97±0.89 <0.001

SphEq (D) -11.6±5.12 -0.52±1.03 <0.001

UDVA(logMAR) 1.72±0.49 (20/1000)

0.23±0.22(20/30)

<0.001

CDVA (logMAR) 0.21±0.17(20/30)

0.12±0.13(20/25)

<0.001

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Results

• 14 eyes presented ICL-related complications (3.44%) including endophthalmitis, TASS, ocular hypertension, toric ICL rotation accidental anterior capsule rupture, large/small vault

• 6 eyes presented complications related with high myopia and/or trauma such as ICL dislocation or retinal detachment (1.47%).

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Complications, managment and visual outcomes

ICL-Related Complication Managment Number of cases (%)

ICL rotation Surgical Lens Rotation 3 (0.73)OVD Retention + Ocular Hipertension

+Large VaultOVD aspiration 1 (0.24)

Vault <100 µ ICL exchange 2 (0.49)Corneal Edema Pharmacologic treatment 1 (0.24)

Ocular hypertension Topical Pharmacologic Treatment 3 (0.73)

Toxic Anterior Segment Sindrome ICL removal 1 (0.24)Recurrent Uveitis Medical Treatment 1 (0.24)Endophthalmitis Intravitreal therapy and vitrectomy 1 (0.24)*

Post-operative open-angle glaucoma Pharmacologic treatment 1 (0.24)

Non-ICL relatedOcular trauma and macular hemorrage

with ICL luxationSurgical lens reposition 1 (0.24)

Myopic Choroidal neovascularization Antiangiogenic therapy 1 (0.24)

Previous retinal detachment Post-scleral buckle ICL implantation 1 (0.24)

Retinal scar from previous myopic CNV 1 (0.24)

Ocular trauma with secondary ocular hypertension and endothelial failure

DSAEK 1 (0.24)

Post-ICL rhegmatogenous retinal detachment with macular involvment

Scleral buckle 1 (0.24)

* Only one patient lost more than 1 line of CDVA (3 lines)

A) TASS, B) Endophthalmitis, C) ICL subluxation after blunt trauma, D) Focal anterior cataract, E) Large vault, F) Small vault,G) Corneal Edema

E

F

G

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Conclusions

• Both models (V4 and V4c) ICL implantation are safe, efficient and predictable for the refractive treatment of high ametropia.

• While ICL complications can occur, most are solvable with minimal changes in visual outcomes.

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