The Change of Retinal Nerve Fiber Layer Thickness after Posterior Chamber Phakic Intraocular Lens Implantation

Tae Hee Lee; Jung Won Park; Se Hyung Jeong; Sang Woo Park

doi:10.3341/jkos.2014.55.5.702

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Lee, Park, Jeong, and Park: The Change of Retinal Nerve Fiber Layer Thickness after Posterior Chamber Phakic Intraocular Lens Implantation

Original Article

J Korean Ophthalmol Soc 201;55(5):702-710.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.702

The Change of Retinal Nerve Fiber Layer Thickness after Posterior Chamber Phakic Intraocular Lens Implantation

Tae Hee Lee, MD, Jung Won Park, MD, Se Hyung Jeong, MD, Sang Woo Park, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Sang Woo Park, MD, PhD, Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea, Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: exo70@naver.com

Received 7 September 2013 Revised 22 November 2013 Accepted 1 April 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

In the present study we evaluated the changes of measured retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) after phakic intraocular lens (implantable collamer lens, ICL) implantation and analyzed the factors correlated with the changes of measured RNFL thickness.

Methods

Forty eyes of 40 patients (Group A: 20 patients using spectral domain OCT and Group B: 20 patients using time domain OCT) who underwent ICL implantation were included in this study. RNFL thickness was measured 1 week before surgery and 1 month postoperatively using OCT. The changes of measured RNFL thickness and the correlation between patients¹ data were analyzed.

Results

The postoperative measured RNFL thickness of the average, inferior, temporal, and superior quadrants were increased compared to preoperative measured RNFL thickness in Group A. Group B had similar results in the average, inferior, and superior quadrants (p < 0.05). However, the postoperative changes of RNFL measurements were not correlated with the preoperative spherical equivalent, the degree of spherical equivalent change and diopters of implanted lens (p > 0.05).

Conclusions

The measured RNFL thickness after ICL implantation may increase compared to the preoperative value. Caution should be taken when interpreting the RNFL thickness values measured by OCT in patients with myopia who undergo ICL implantation.

Keywords: Optical coherence tomography, Phakic intraocular lens implantation, Retinal nerve fiber layer

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Figure 1.

Optical coherence tomography (OCT) findings, Spectralis OCT (A) and Stratus OCT (B). (A) Data of six sectors of retinal nerve fiber layer (RNFL) thickness, including temporal (T), temporal superior (TS), temporal inferior (TI), nasal (N), nasal superior (NS), nasal inferior (NI) and were used (black arrow). Average thickness of RNFL were calculated by mean value of these six sectors. Superior quadrant and inferior quadrant data were obtained from mean value of TS and nasal superior (NS), TI and NI, respectively. (B) Data from the four quadrants of RNFL thickness were obtained in this Stratus OCT result (asterix), and the average thickness of RNFL were obtained from the table (arrow head).

Figure 2.

Correlation of preoperative retinal nerve fiber layer (RNFL) thickness with the amounts of RNFL thickness change in average and each quadrants in Spectralis optical coherence tomography (OCT) group (group A). There were statistically significant negative correlation in preoperative average, nasal, inferior and temporal quadrant RNFL thickness with amounts of average, nasal, inferior and temporal increase, respectively.

Figure 3.

Correlation of preoperative retinal nerve fiber layer (RNFL) thickness with the amounts of RNFL thickness change in average and each quadrants in Stratus optical coherence tomography (OCT) group (group B). There were statistically significant negative correlation in RNFL thickness of preoperative average, nasal and superior quadrant thickness with amounts of average, nasal, superior increase, respectively, which were similar results compared with Spectralis OCT group (group A).

Table 1.

Preoperative characteristics of patients who underwent ICL implantation

	Group A^*	Group B^†	p-value
Total number of eyes (M:F)	20 (7:13)	20 (5:15)	0.50
Age (years)	30.6 ± 5.9 (21-44)	29.4 ± 5.2 (20-40)	0.48
Spherical equivalent (diopter)	-9.4 ± 2.4 (-12.50∼-5.25)	-9.9 ± 2.5 (-15.25∼-4.25)	0.54
Anterior chamber depth (mm)	3.22 ± 0.16 (3.1-3.55)	3.32 ± 0.23 (3.02-3.70)	0.13
Implanted ICL spherical equivalent (diopter)	-14.1 ± 2.9 (-19.5∼-9.0)	-14.2 ± 3.1 (-20.5∼-6.0)	0.96
Image quality (Signal strength/dB)	8.8 ± 0.70 (8-10)	25.65 ± 1.50 (23-29)	-

Values are presented as mean ± SD; Statistically significant, if p < 0.05.

M = male; F = female; ICL = implantable collamer lens.

^* Spectralis OCT group;

^† Stratus OCT group.

Table 2.

Preoperative, postoperative and amounts of increase of retinal nerve fiber layer thickness by Spectralis (group A) and Stratus (group B) optical coherence tomography

	Preoperative	Postoperative	Amount of increase	p-value
Average (μm)
Group A^*	96.4 ± 9.7	101.2 ± 8.0	4.8 ± 5.3	<0.01^‡
Group B^†	93.9 ± 5.6	99.1 ± 5.3	5.2 ± 6.6	<0.01^‡
Nasal (μm)
Group A^*	55.5 ± 16.0	57.5 ± 13.9	2.0 ± 7.2	0.16
Group B^†	56.2 ± 10.9	60.8 ± 11.0	4.6 ± 11.4	0.09
Inferior (μm)
Group A^*	117.5 ± 16.0	121.8 ± 15.2	4.3 ± 8.3	0.03^‡
Group B^†	118.1 ± 12.0	123.3 ± 14.3	5.2 ± 9.6	0.03^‡
Temporal (μm)
Group A^*	82.7 ± 12.7	88.8 ± 12.8	6.2 ± 8.2	<0.01^‡
Group B^†	91.8 ± 14.5	96.4 ± 23.7	4.7 ± 14.8	0.17
Superior (μm)
Group A^*	102.6 ± 14.2	108.6 ± 14.2	6.0 ± 8.8	<0.01^‡
Group B^†	109.2 ± 16.1	116.2 ± 15.0	7.0 ± 11.4	0.01^‡

Values are presented as mean ± SD.

^* Spectralis OCT group;

^† Stratus OCT group;

^‡ Statistically significant, ifp < 0.05.

Table 3.

Correlation analysis between amounts of retinal nerve fiber layer thickness change and preoperative spherical equivalent, amounts of spherical equivalent change, and implanted ICL diopters

	Preoperative SE	Changes of SE	ICL diopters
Average
Group A^*	r^‡ = −0.06	r^‡ = 0.08	r^‡ = −0.05
Group B^†	r^‡= −0.31	r^‡ = 0.23	r^‡ = −0.25
Nasal
Group A^*	r^‡ = −0.07	r^‡ = 0.06	r^‡ = −0.05
Group B^†	r^‡ = −0.09	r^‡ = −0.04	r^‡ = −0.03
Inferior
Group A^{^*}	r^‡ = −0.04	r^‡ = 0.05	r^‡ = −0.01
Group B^†	r^‡ = −0.32	r^‡ = 0.25	r^‡ = −0.27
Temporal
Group A^{^*}	r^‡ = −0.14	r^‡ = −0.01	r^‡ = −0.12
Group B^†	r^‡ = −0.12	r^‡ = 0.14	r^‡ = −0.12
Superior
Group A^{^*}	r^‡ = −0.07	r^‡ = 0.06	r^‡ = −0.04
Group B^†	r^‡ = −0.15	r^‡ = 0.14	r^‡ = −0.14

SE = spherical equivalent; ICL = implantable collamer lens.

^* Spectralis OCT group;

^† Stratus OCT group;

^‡ Pearson's coefficient, all p > 0.05.

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