Risk Factors for Cataract Formation after Implantable Collamer Lens Implantation: Over a Mean 7.5-Year Follow-Up Period

Damho Lee; Ju Yong Seok; Hak Su Kyung; Joon Mo Kim

doi:10.3341/jkos.2015.56.6.835

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Lee, Seok, Kyung, and Kim: Risk Factors for Cataract Formation after Implantable Collamer Lens Implantation: Over a Mean 7.5-Year Follow-Up Period

Original Article

J Korean Ophthalmol Soc 2015;56(6):835-846.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.6.835

Risk Factors for Cataract Formation after Implantable Collamer Lens Implantation: Over a Mean 7.5-Year Follow-Up Period

Damho Lee, MD, PhD¹, Ju Yong Seok, MD², Hak Su Kyung, MD, PhD³, Joon Mo Kim, MD, PhD⁴

¹Vision Eye Center, Seoul, Korea

²Department of Ophthalmology, Korea Army Training Center District Hospital, Nonsan, Korea

³Department of Ophthalmology, National Medical Center, Seoul, Korea

⁴Department of Ophthalmology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, 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 27 June 201417 October 2014 Accepted 15 January 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.

Abstract

Purpose

To determine the risk factors and incidence of cataract formation over a long-term mean follow-up of 7.5 years after type V4 implantable collamer lens (ICL) implantation.

Methods

We analyzed the preoperative, 3-month postoperative, 3-year postoperative, and last follow-up data of 228 eyes (118 patients) with mean preoperative spherical equivalent of -12.7 D and minimum postoperative follow-up of 3 years. Additionally, we determined the risk factors for cataract formation and calculated the 10.3 year cumulative cataract formation rate and 10.3 year cumulative cataract surgery rate using a survival curve.

Results

After type V4 ICL implantation with minimum follow-up of 3 years, the calculated 10.3 year cumulative cataract formation rate was 20% and actual cataracts developed in 34 eyes (14.9%). The 10.3 year cumulative cataract surgery rate was 12% based on a survival curve and actual cataract surgery was performed in 12 eyes (5.3%). The risk factors for cataract formation were age (odds ratio [OR] = 1.10, p = 0.00), preoperative spherical equivalent (OR = 0.90, p = 0.00), crystalline lens thickness (OR = 9.54, p = 0.00), axial length (OR = 1.33, p = 0.00), 3 months postoperative vault (OR = 0.50, p = 0.03), and existence of peripheral touch between ICL optic margin and crystalline lens at last follow-up (OR = 7.84, p = 0.00).

Conclusions

We suggest one of the main risk factors for cataract formation after ICL implantation is decreased central vault and peripheral touch between ICL optic margin and crystalline lens.

Keywords: Cataract formation, ICL implantation, Peripheral touch, Risk factors

References

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Figure 1.

Superior or inferior peripheral crystalline lenticular touch by superior or inferior periphery of implantable collamer lens (ICL). (A) The arrows indicate the superior or inferior periphery of ICL is not touching the crystalline lens and there is no cataract formation. (B) It shows visually significant anterior subcapsular opacity. (C) The same eye with (B) shows the superior periphery of ICL is touching the crystalline lens (arrow).

Figure 2.

Life table for cataract formation after implantable collamer lens (ICL) implantation. The moments when the initial cataract developed in group A or B patients after ICL implantation were regarded as “censored” in this survival curve.

Figure 3.

Life table for cataract surgery after implantable collamer lens (ICL) implantation. The moments when the patients in group A underwent cataract surgery were regarded as “censored” in this survival curve.

Table 1.

Preoperative patient demographics

Parameter	Value	Range
Age (years)	31.0 ± 8.3	19~54
Sex and eyes (n)
Male/eyes	31/60
Female/eyes	87/168
Follw up (years)	7.5 ± 1.9	3~10.3
SE (diopters)	-12.7 ± 4.4	-4.6~-28.3
IOP (mm Hg)	15.1 ± 3.0	9~23
LT (mm)	3.74 ± 0.29	3.20~4.54
ACD (mm)	3.15 ± 0.29	2.8~4.36
AXL (mm)	28.09 ± 1.88	24.52~33.54
WWD (mm)	11.6 ± 0.39	10.8~13.0
CCT (μ m)	529 ± 34	449~610
Mean BCVA	0.96 ± 0.35	0.15~1.5
Mean UCVA	0.03 ± 0.05	0.01~0.4

Values are presented as mean ± SD unless otherwise indicated. Age = age at implantable collamer lens implantation; SE = spherical equivalent; IOP = intraocular pressure; LT = crystalline lens thickness; ACD = anterior chamber depth; AXL = axial length; WWD = white to white diameter measured with caliper; CCT = central corneal thickness; BCVA = best corrected visual acuity; UCVA = uncorrected visual acuity.

Table 2.

Time to develop initial late onset cataract^*

	Time to initial cataract (years)	Range (years)
Group A (n = 13)	2.6 ± 2.0	0.3-4.5
Group B (n = 21)	4.7 ± 1.3	0.9-9.1

Values are presented as mean ± SD unless otherwise indicated.

^* p = 0.00.　

Table 3.

Patterns of cataract after ICL implantation (number of eyes)

	ASCO only	PSCO only	NS only	ASCO + PSCO	ASCO + NS	ASCO +NS + PSCO	NS + PSCO	Total
Group A	4	0	1	6	1	1	0	13
Group B	10	4	0	6	0	0	1	21

ICL = implantable collamer lens; ASCO = anterior subcapsular opacity; PSCO = posterior subcapsular opacity; NS = nuclear sclerosis.

Table 4.

Touch between ICL optic periphery and crystalline lens at last follow up^*

	Group A (n = 13)	Group B (n = 21)	Group C (n = 194)
No. of eyes (%)	6 (46)	2 (10)	4 (2)

ICL = implantable collamer lens.

^* p = 0.00. Based on Chi-square test.

Table 5.

Risk factors for cataract formation after ICL implantation by univariate Cox’s propotional hazards

Parameter	Group A + B (34 eyes)(Cataract group)	Group C (194 eyes)(No cataract group)	OR (95% CI)	p-value
Age (years)	38.0 ± 8.3	29.8 ± 7.6	1.10 (1.06-1.14)	0.00
Preoperative SE (diopters)	-15.2 ± 4.6	-12.2 ± 4.2	0.90 (0.84-0.96)	0.00
Preoperative LT (mm)	3.92 ± 0.36	3.71 ± 0.26	9.54 (3.19-28.51)	0.00
Preoperative AXL (mm)	29.2 ± 1.70	27.9 ± 1.84	1.33 (1.13-1.57)	0.00
Vault 3m (CCT)	1.3 ± 0.6	1.5 ± 0.7	0.50 (0.27-0.94)	0.03
	(range 0-3.0)	(range 0.3-4.0)
Last peripheral touch^* (eyes)	8/34 (24%)	4/194 (2%)	7.84 (3.53-17.39)	0.00

Values are presented as mean ± SD unless otherwise indicated.

ICL = implantable collamer lens; OR = odds ratio; CI = confidence interval; Age = age at ICL implantation; SE = spherical equivalent; LT = crystalline lens thickness; AXL = axial length of eye; Vault 3m = vault 3 months after ICL implantation; CCT = central corneal thickness.

^* Existence of peripheral touch between ICL optic margin and crystalline lens at last follow up.

Table 6.

Comparison of crystalline lens thickness between cataract group and no cataract group^*

	Group A + B (Cataract group)	Group C (No cataract group)
Preoperative LT >4 mm (eyes)	13 (38)	23 (12)
Preoperative LT ≤4 mm (eyes)	21 (62)	171 (88)
Total	34 (100)	194 (100)

Values are presented as n (%).

LT = crystalline lens thickness.

^* p = 0.00. Based on Chi-square test

Table 7.

Comparison of age between cataract group and no cataract group in eyes with thick crystalline lens^*

	Group A + B (Cataract group)	Group C (No cataract group)
	Group A + B (Cataract group)	Group C (No cataract group)	Preoperative LT >4 mm, Age ≤35 (eyes)	2 (15)	11 (48)
Preoperative LT >4 mm, Age >35 (eyes)	11 (85)	12 (52)
Total	13 (100)	23 (100)

Values are presented as n (%).

LT = crystalline lens thickness.

^* p = 0.05. Based on Fisher’s exact test.

Table 8.

Risk factors for clinically significant cataract formation by univariate Cox’s propotional hazards

Parameter	Group A (13 eyes)	Group B (21 eyes)	OR (95% CI)	p-value
Vault 3mo (CCT)	0.9 ± 0.3 (range 0.4-1.3)	1.5 ± 0.7 (range 0-3.0)	0.29 (0.11-0.75)	0.01
Last peripheral touch^* (eyes)	6/13 (46%)	2/21 (10%)	4.19 (1.27-13.79)	0.02

Values are presented as mean ± SD unless otherwise indicated.

OR = odds ratio; CI = confidence interval; Vault 3mo = vault 3 months after implantable collamer lens (ICL) implantation; CCT = central corneal thickness.

^* Existence of peripheral touch between ICL optic margin and crystalline lens at last follow up.

Table 9.

Changes of postoperative values over time after ICL implantation

		3 months	3 years	Last follow up	p-value
Group A	SE (diopters)	-1.3 ± 1.7	-2.7 ± 1.7	-3.3 ± 2.7	0.045
(n = 13)	UCVA	0.67 ± 0.32	0.52 ± 0.26	0.46 ± 0.35	0.151
	Vault (CCT)	0.92 ± 0.29	0.83 ± 0.47	0.71 ± 0.40	0.017
Group B	SE (diopters)	-1.3 ± 0.9	-1.9 ± 1.3	-2.2 ± 1.5	0.000
(n = 21)	UCVA	0.77 ± 0.32	0.72 ± 0.29	0.65 ± 0.33	0.157
	Vault (CCT)	1.48 ± 0.70	1.48 ± 0.89	1.17 ± 0.85	0.001
Group C	SE (diopters)	-0.9 ± 1.0	-1.3 ± 1.1	-1.6 ± 1.4	0.000
(n = 194)	UCVA	0.89 ± 0.33	0.84 ± 0.31	0.80 ± 0.33	0.000
	Vault (CCT)	1.54 ± 0.68	1.50 ± 0.79	1.30 ± 0.90	0.000

Values are presented as mean ± SD unless otherwise indicated.

ICL = implantable collamer lens; SE = spherical equivalent; UCVA = uncorrected visual acuity; CCT = central corneal thickness.

Table 10.

Adverse events after ICL implantation

Adverse event	No. of eyes
Retinal detachment	2 (0.9)
Myopic CNV	3 (1.3)
Pigment dispersion glaucoma	2 (0.9)
Turbid ICL	2 (0.9)
Immediate postoperative sterile hypopyon	2 (0.9)
Total	11 (4.8)

Values are presented as n (%).

ICL = implantable collamer lens; CNV = choroidal neovascularization.

Table 11.

Causes of ICL exchange

Causes of ICL exchange	No. of eyes
Low vault with cataract formation risk	6 (2.6)
Decenteraion with decreased visual acuity	5 (2.1)
Exchange to TICL	2 (0.9)
Iris-corneal endothelium touch due to high vault	1 (0.4)
Halo due to high vault	5 (2.1)
Total	19 (8.3)

Values are presented as n (%).

ICL = implantable collamer lens; TICL = toric implantable collamer lens.

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