Rotational Stability after Toric Implantable Collamer Lens Implantation

Damho Lee; Seung Jae Lee; Haksu Kyung

doi:10.7469/JKOS.2015.56.04.477

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Lee, Lee, and Kyung: Rotational Stability after Toric Implantable Collamer Lens Implantation

Original Article

J Korean Ophthalmol Soc 2015;56(4):477-484.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.477

Rotational Stability after Toric Implantable Collamer Lens Implantation

Damho Lee, MD, PhD¹, Seung Jae Lee, MD², Haksu Kyung, MD, PhD²

¹Vision Eye Center, Seoul, Korea

²Department of Ophthalmology, National Medical Center, Seoul, Korea

￭ Address reprint requests to Damho Lee, MD, PhD Vision Eye Center, #867 Nonhyeon-ro, Gangnam-gu, Seoul 135-892, Korea Tel: 82-2-548-3579, Fax: 82-2-540-1431 E-mail: damholee@naver.com

Received 26 April 201426 September 2014 Accepted 7 March 2015

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.

초록

Purpose:

To evaluate rotational stability of Toric Implantable Collamer Lens (ICL) implantation to correct myopic astigmatism.

Methods:

We estimated the degree of Toric ICL rotation together with change in visual acuity and astigmatism in 118 eyes of 66 patients who underwent Toric ICL implantation and had a long-term mean follow-up period of 37 months.

Results:

After Toric ICL implantation, 107 (91%) out of 118 eyes showed uncorrected visual acuity of 0.8 or better. The mean postoperative astigmatism decreased to -0.64 ± 0.61 D from a mean preoperative astigmatism of -2.96 ± 1.13 D. The mean axis change of Toric ICL was 2.4 ± 3.8 degrees during follow-up period. Two (1.7%) out of 118 eyes showed the axis change of more than 10 degrees. These two eyes had a decrease in visual acuity, rotational axis change of 18 degrees and 30 degrees, respectively, and increases in astigmatism of 1.50 D and 1.00 D, respectively. The remaining 116 eyes (98.3%) showed excellent rotational stability without visual acuity decreasing Toric ICL rotation during the follow-up period.

Conclusions:

Toric ICL implantation to correct high myopia with astigmatism rarely has axis rotation and maintains excellent rotational stability for long-term follow-up.

Keywords: Myopic astigmatism, Rotational stability, Toric ICL

References

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Figure 1.

Mean log MAR uncorrected distance visual acuity (UCVA) and log MAR best-corrected distance visual acuity before and after Toric ICL implantation. The preoperative mean log MAR UCVA of +1.71 ± 0.41 changed to -0.02 ±0.41 at last follow-up. And the preoperative mean log MAR corrected visual acuity of +0.03 ± 0.08 changed to -0.05 ±0.09 at last follow-up. ICL = implantable collamer lens; BCVA = best-corrected distance visual acuity.

Figure 2.

Comparison between preoperative cylinder and postoperative last follow-up cylinder after Toric ICL implantation. The postoperative cylinder at last follow-up was within 0.50 D in 66 eyes (56%) and within 1.00 D in 105 eyes (89%). ICL = implantable collamer lens.

Figure 3.

Toric ICL axis change after the surgery. The Toric ICL axis changes until the last follow-up were within 5 degrees in 107 eyes (90.7%), between more than 5 degrees and 10 degrees or less in 9 eyes (7.6%), and over 10 degrees in 2 eyes (1.7%). ICL = implantable collamer lens.

Table 1.

Preoperative profile

Parameter	Number	Mean ± SD	Range
Patients	66
Eyes	118
Sex
Male	22
Female	44
Age (years)		28.5 ± 7.10	19-50
Refractive sphere (diopter)		-8.47 ± 2.94	-1.25~-17.5
Refractive cylinder (diopter)		-2.96 ± 1.13	-1.0~-7.0
Spherical equivalent (diopter)		-9.95 ± 3.12	-4.0~-19.5
K power (diopter)		44.36 ± 1.29	41.00-48.35
Axial length (mm)		27.08 ± 1.31	23.12-30.14
Anterior chamber depth (mm)		3.33 ± 0.24	2.80-3.91
Horizontal white-to-white diameter (mm)^*		11.84 ± 0.34	11.0-12.9
Corneal thickness (μ m)		519 ± 36	422-598
ICL size (mm)		12.26 ± 0.32	11.5-13.0
ICL sphere (diopter)		-16.65 ± 3.88	-8.5~-23.0
ICL cylinder (diopter)		+3.79 ± 1.21	+1.5~+6.0
Mean follow-up (month)		37.1 ± 24.1	3-80

K = keratometer; ICL = implantable collamer lens.

^* Measured by corneal topography.

Table 2.

Cycloplegic refractive spherical equivalent (SE) on 1 month and last follow-up after Toric ICL implantation

Refractive SE (diopter)^*	Eyes (n, %)
Refractive SE (diopter)^*	Preoperative	Month 1	Last follow-up
0.0	0	7 (5.9)	13 (11.1)
0.0 < D ≤ 0.5	0	35 (29.7)	66 (55.9)
0.5 < D ≤ 1.0	0	54 (45.8)	29 (24.6)
1.0 < D ≤ 2.0	0	20 (16.9)	9 (7.6)
2.0 < D	118 (100)	2 (1.7)	1 (0.8)
Mean SE ± SD	-9.95 ± 3.12	+0.66 ± 0.57	+0.03 ± 0.66

ICL = implantable collamer lens.

^* Refractive SE is absolute value of SE.

Table 3.

Cycloplegic refractive cylinder at 1 month and last follow-up after Toric ICL implantation

Refractive cylinder (diopter)^*	Eyes (n, %)
Refractive cylinder (diopter)^*	Preoperative	Month 1	Last follow-up
0.0	0	32 (27.1)	25 (21.2)
0.0 < D ≤ 0.5	0	40 (33.9)	41 (34.7)
0.5 < D ≤ 1.0	0	34 (28.8)	39 (33.1)
1.0 < D ≤ 2.0	28 (24)	10 (8.5)	8 (6.8)
2.0 < D	90 (76)	2 (1.7)	5 (4.2)
Mean cylinder ± SD	-2.96 ± 1.13	-0.54 ± 0.49	-0.64 ± 0.61

ICL = implantable collamer lens.

^* Refractive cylinder is absolute value of cylindrical diopter.

Table 4.

Toric ICL vault on 1 month and last follow-up after Toric ICL implantation

Vault (CCT)	Eyes (n, %)
Vault (CCT)	Month 1	Last follow-up
Vault<1	0 (0)	0 (0)
1 ≤ vault < 2	22 (18.6)	49 (41.5)
2 ≤ vault < 3	39 (33.1)	29 (24.6)
3 ≤ vault < 4	24 (20.3)	25 (21.2)
4 ≤ vault < 5	20 (17.0)	11 (9.3)
5 ≤ vault	13 (11.0)	4 (3.4)
Mean vaulting ± SD	3.0 ± 1.3	2.4 ± 1.1

ICL = implantable collamer lens; CCT = central corneal thickness.

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