Implantable Collamer Lens Complications

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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 devices Email: aolivo10@gmail.com INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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 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 INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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 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 INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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. INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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 INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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 INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

INSTITUTO DE OFTALMOLOGÍA 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 SphEq (D) -11.6±5.12 -0.52±1.03 UDVA(logMAR) 1.72±0.49 (20/1000) 0.23±0.22 (20/30) CDVA (logMAR) 0.21±0.17 0.12±0.13 (20/25) INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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%). INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA

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 Vault OVD aspiration 1 (0.24) Vault <100 µ ICL exchange 2 (0.49) Corneal Edema Pharmacologic treatment Ocular hypertension Topical Pharmacologic Treatment Toxic Anterior Segment Sindrome ICL removal Recurrent Uveitis Medical Treatment Endophthalmitis Intravitreal therapy and vitrectomy 1 (0.24)* Post-operative open-angle glaucoma Non-ICL related Ocular trauma and macular hemorrage with ICL luxation Surgical lens reposition Myopic Choroidal neovascularization Antiangiogenic therapy Previous retinal detachment Post-scleral buckle ICL implantation Retinal scar from previous myopic CNV Ocular trauma with secondary ocular hypertension and endothelial failure DSAEK Post-ICL rhegmatogenous retinal detachment with macular involvment Scleral buckle * Only one patient lost more than 1 line of CDVA (3 lines)

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

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. INSTITUTO DE OFTALMOLOGÍA FUNDACIÓN CONDE DE VALENCIANA