Short-term Clinical Outcomes of Implantable Collamer Lens Implantation with Simultaneous Full Thickness Astigmatic Keratotomy

Kim Buki; Mun Sujoung; Choi Hyuntae; Chung Youngtaek

doi:10.3341/jkos.2017.58.8.916

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Buki, Sujoung, Hyuntae, and Youngtaek: Short-term Clinical Outcomes of Implantable Collamer Lens Implantation with Simultaneous Full Thickness Astigmatic Keratotomy

Original Article

J Korean Ophthalmol Soc 2017;58(8):916-923.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.8.916

Short-term Clinical Outcomes of Implantable Collamer Lens Implantation with Simultaneous Full Thickness Astigmatic Keratotomy

Kim Buki, M.D., Mun Sujoung, M.D., PhD, Choi Hyuntae, M.D., Chung Youngtaek, M.D., PhD

Onnuri Smile Eye Clinic, Seoul, Korea

Address reprint requests to Youngtaek Chung, MD, PhD Onnuri Smile Eye Clinic, #Hyobong building 9F, 1 Gangnam-daero 65-gil, Seocho-gu, Seoul 06614, Korea Tel: 82-2-6913-0000, Fax: 82-2-532-5406 E-mail: ytchungc@daum.net

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 18 May 201730 June 2017 Accepted 21 July 2017

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 clinical outcomes of implantable collamer lens (ICL) implantation with simultaneous full thickness as-tigmatic keratotomy (FTAK) for the correction of moderate to high myopic astigmatism.

Methods

Thirty-two eyes of 16 patients who had an ICL implantation with simultaneous FTAK were studied. Follow-up visits were at 1 week, 1 month, and 3 months. The outcome measures included the uncorrected distance visual acuity (UDVA), re-fractive error, efficacy, safety, and predictability.

Results

After the surgery, astigmatism was reduced by 74.83 ± 13.8%. The proportion of eyes with a spherical equivalent of 0.5 D or less was 87.5%, and all eyes had a spherical equivalent of 1.0 D or less at 3 months after the surgery. The proportion of eyes with a UDVA of 20/25 or better was 100%, and 20/20 or better was 81.25%. Reoperation was needed in one case (3.1%) because of undercorrection of the astigmatism, and no complications were observed.

Conclusions

This study showed that ICL implantation with simultaneous FTAK is effective and safe for the correction of moder-ate to high myopic astigmatism.

Keywords: Astigmatic keratotomy, Astigmatism, High astigmatism, Implantable collamer lens, Toric Implantable collamer lens

References

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Figure 1.

Implantable collamer lens implantation with full thickness astigmatic keratotomy. (A) Corneal marking at the steepest axis with marking pen using CALLISTO eye® system (Carl Zeiss Meditec AG, Jena, Germany). (B) Ring marking using a ring marker with cross wires (7.5 mm). (C) Beveled, full thickness corneal incision at the steepest axis with a 2.8 mm blade. (D) Implantable collamer lens implantation through the incision. (E) Extension of the cor-neal incision with a wider blade.

Figure 2.

Vector analysis of astigmatism. This polar plot shows the reduction in astigmatism after implantable collamer lens im-plantation with simultaneous astigmatic keratotomy. Gray dots (postoperative) are closer to the center compared to black dots (preoperative). Pre-op = preoperation; Post-op = postoperation.

Figure 3.

Stability of the implantable collamer lens im-plantation with simultaneous astigmatic keratotomy. Spherical equivalent refraction of combined procedure is stable for 3 months. Preop = preoperation.

Figure 4.

Predictability of the implantable collamer lens im-plantation with simultaneous astigmatic keratotomy. Scatterplot of the attempted spherical equivalent refractive change plotted against the achieved spherical equivalent change at 3 months.

Figure 5.

Safety of the implantable collamer lens implantation with simultaneous astigmatic keratotomy. The percentage of eyes in which there was a gain/loss of Snellen visual acuity lines (CDVA). CDVA = corrected distance visual acuity.

Table 1.

Nomogram of the beveled, full-thickness astigmatic ker-atotomy

Distance from corneal marking (mm)	Incision width (mm)	Corrected astigmatism (D)
1.5	2.8	0.75
1.5	4.1	1.25
1.5	5.7	2.5
1.0	2.8	1
1.0	4.1	1.75
1.0	5.7	3
0.5	4.1	2
0.5	5.7	3.5
0	5.7	4.5

Table 2.

Demographics of the patients

Characteristics	Data
Eyes (n)	32
Sex (male/female)	10/22
Age (years)	24.0 ± 4.76 (18~32)
UDVA (logMAR)	1.52 ± 0.23 (1.0~1.7)
CDVA (logMAR)	-0.03 ± 0.06 (-0.1~0.1)
IOP (mmHg)	14.41 ± 3.82 (9.0~17)
Sphere (diopter)	-10.11 ± 2.20 (-14.25~-6.0)
Cylinder (diopter)	-2.98 ± 1.1 (-6.75~-2.0)
Spherical equivalence	-11.57 ± 2.54 (-15.75~-7.0)
(diopter)
WTW (mm)	11.42 ± 0.34 (10.71~11.75)
ACD (mm)	3.24 ± 0.16 (3.01~3.57)
Endothelium (cells/mm²)	2,990.12 ± 136.28 (2,747~3,295)

Values are presented as mean ± SD (range) unless otherwise indicated. UDVA = uncorrected distance visual acuity; logMAR = logarithm of the minimum angle of resolution; CDVA = corrected distance visual acuity; IOP = intraocular pressure; WTW = white to white; ACD = anterior chamber depth.

Table 3.

Pre- and post-operative clinical data comparison in patients who underwent implantable collamer lens implantation with si-multaneous astigmatic keratotomy

Measurement	Preoperative	POD 3 months	p-value
Sphere (diopter)	-10.11 ± 2.20	0.53 ± 0.30	<0.001
Cylinder (diopter)	-2.98 ± 1.1	-0.72 ± 0.38	<0.001
Spherical equivalence (diopter)	-11.57 ± 2.54	0.18 ± 0.29	<0.001
UDVA (logMAR)	1.52 ± 0.23	-0.03 ± 0.07	<0.001
CDVA (logMAR)	-0.03 ± 0.06	-0.04 ± 0.05	0.133
Values are presented as mean ± SD.

POD = postoperative day; UDVA = uncorrected distance visual acuity; logMAR = logarithm of the minimum angle of resolution; CDVA = corrected distance visual acuity.

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