The Analysis of Vault Change after Posterior Chamber Phakic Intraocular Lens Size Exchang

Wook Kyum Kim; Eun Young Cho; Hee Sun Kim; Jin Kuk Kim

doi:10.3341/jkos.2013.54.11.1669

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Kim, Cho, Kim, and Kim: The Analysis of Vault Change after Posterior Chamber Phakic Intraocular Lens Size Exchang

Original Article

J Korean Ophthalmol Soc 2013;54(11):1669-1674.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1669

The Analysis of Vault Change after Posterior Chamber Phakic Intraocular Lens Size Exchang

Wook Kyum Kim, MD, Eun Young Cho, MD, Hee Sun Kim, MD, Jin Kuk Kim, MD

B&VIITEye Center, Seoul, Korea

Address reprint requests to Jin Kuk Kim, MD, B&VIIT Eye Center, 14F Ala Tower, #3 Seochodaero77-gil, Seocho-gu, Seoul 137-856, Korea Tel: 82-2-501-6800, Fax: 82-2-501-6435, E-mail: kimjinkuk@hanmail.net

Received 5 April 2013 Revised 19 June 2013 Accepted 9 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the vault change after implantable collamer lens (ICL) size exchange according to the preoperative vault.

Methods

In 14 eyes of 13 patients, the vault change after ICL exchange operation due to unideal vault was compared in 2 groups, the smaller ICL exchanged group and larger ICL exchanged group.

Results

In 6 out of 14 eyes, the ICL was exchanged to a 0.5 mm smaller size and the vault was changed from 1.38 mm (1.18-1.70) to 0.71 mm (0.51-0.92) (p = 0.03). In 8 eyes, the ICL was exchanged to a 0.5 mm bigger size and the vault was changed from 0.07 mm (0.03-0.13) to 0.50 mm (0.12-1.01) (p < 0.01). The exchange operation was performed at 3.5 postoperative days (1-6) if the ICL was exchanged to 1 step smaller size, but the exchange operation was performed at 135 postoperative days (90-660) if the ICL was exchanged to 1 step bigger size (p < 0.01).

Conclusions

ICL exchange to 1 step smaller or bigger size is an effective method to correct unideal postoperative vault to a more ideal vault size. The exchange to 1 step smaller size ICL tended to be performed sooner.

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Keywords: Exchange, Implantable collamer lens, Phakic intraocular lens, Vault

References

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Table 1.

Basic characteristics of 14 eyes of 13 patients who received ICL size exchange

Characteristics	Values (range)
Sex (male : female)	3:10
Age (years)	25 (20 ∼ 36)
Eye (right : left)	9:5
Preoperative Spherical equivalent (diopters)	−8.44 (-5.50∼-13.00)
Preoperative BCVA (log MAR)	0.00 (-0.10∼0.00)
Preoperative IOP (mm Hg)	13 (10 ∼ 21)
Scotopic pupil size (mm)	6.6 (5.6 — 7.5)
Initially Implanted ICL size (mm)	12.0 (11.5 — 12.5)
Postoperative spherical equivalent (diopters)	−0.32 (-0.75∼+0.25)
Postoperative UCVA (log MAR)	−0.10 (-0.10 — −0.10)
Postoperative IOP (mm Hg)	14 (10—16)

BCVA = best corrected visual acuity; IOP = intraocular pressure; UCVA = uncorrected visual acuity.

Table 2.

The data related with postoperative ICL vault in 14 eyes of 13 patients who received ICL size exchange. 14 eyes were div- ided into two groups according to the exchanged ICL size is increased or decreased

Groups	Number of case	Age (years)	ACD internal (mm)	WTW with topography (mm)	ICL size at initial implantation (mm)	Vault before exchange (mm)	Vault after exchange (mm)	Change of vault after exchange (mm)
0.5 mm smaller size ICL exchanged group	1	32	3.80	11.8	12.5	1.70	0.92	−0.78
	2	21	3.21	11.8	12.5	1.43	0.71	−0.72
	3	23	3.42	11.7	12.0	1.50	0.70	−0.80
	4	23	3.36	11.8	12.5	1.19	0.51	−0.68
	5	23	3.37	11.8	12.5	1.33	0.72	−0.61
	6	20	3.41	12.0	12.5	1.18	0.57	−0.61
	Median	23	3.39	11.8	12.5	1.38	0.71	−0.70
	(range)	(20-32)	(3.21-3.80)	(11.7-12.0)	(12.0-12.5)	(1.18-1.70)	(0.51-0.92)	((-0.61) - (-0.80))
0.5 mm lager size ICL exchanged group	1	36	3.07	11.6	11.5	0.07	0.50	+0.43
	2	29	3.00	11.9	12.0	0.04	0.50	+0.46
	3	26	3.19	11.8	12.0	0.03	0.25	+0.22
	4	26	3.32	12.1	12.0	0.12	0.50	+0.38
	5	27	2.99	11.5	11.5	0.04	0.33	+0.29
	6	24	2.97	11.6	11.5	0.10	0.12	+0.02
	7	27	2.93	11.4	11.5	0.06	0.84	+0.78
	8	22	2.97	11.6	11.5	0.13	1.01	+0.88
	Median	26	3.00	11.6	11.5	0.07	0.50	+0.41
	(range)	(22-36)	(2.93-3.32)	(11.4-12.1)	(11.5-12.0)	(0.03-0.13)	(0.12-1.01)	(0.02-0.88)

ACD = anterior chamber depth; WTW = white to white distance.

Table 3.

The comparison of factors related postoperative vault by two groups which were divided according to the fact that the exchanged ICL size is increased or decreased than the initial implanted ICL

	Exchange to smaller ICL (6 eyes)	Exchange to larger ICL (8 eyes)	p-value^*
Age (years)	23 (20-32)	26 (22-36)	0.07
ACD internal (mm)	3.39 (3.21-3.80)	3.00 (2.93-3.32)	<0.01
Lens thickness (mm)	3.65 (3.41-3.83)	3.85 (3.47-4.26)	0.25
WTW (mm)	11.8 (11.7-12.0)	11.6 (11.4-12.1)	0.19
Initial ICL size (mm)	12.5 (12.0-12.5)	11.5 (11.5-12.0)	<0.01
Exchanged ICL size (mm)	12.0 (11.5-12.0)	12.0 (12.0-12.5)	0.08
Vault before exchange (mm)	1.38 (1.18-1.70)	0.07 (0.03-0.13)	<0.01
Vault after exchange (mm)	0.71 (0.51-0.92)	0.50 (0.12-1.01)	0.09
Change of vault	0.70 (0.61-0.80)	0.41 (0.02-0.88)	0.08

ACD = anteriorchamber depth; WTW = white to white distance.

^* Mann-Whitney U test was done.

Table 4.

The analysis of postoperative vault in 14 eyes in which ICL size exchange was performed

	Vault (mm)		p-value	Exchange time after primary operation (days)	p-value
	Before exchange	After exchange	p-value	Exchange time after primary operation (days)	p-value
0.5 mm smaller ICL (6 eyes)	1.38 (1.18-1.70)	0.71 (0.51-0.92)	0.03^*	3.5 (1-6)	<0.01^†
0.5 mm larger ICL (8 eyes)	0.07 (0.03-0.13)	0.50 (0.12-1.01)	<0.01^*	135 (90-660)	<0.01^†

^* Wilcoxon test was done;

^† Mann-Whitney U test was done.

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