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

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.

Occlusive Retinal Vasculitis Associated with Intravenous Ceftriaxone Injection

PURPOSE: To report a case of bilateral occlusive retinal vasculitis presumed to be associated with intravenous ceftriaxone injection. CASE SUMMARY: A 26-year-old woman presented with a sudden visual impairment which developed 2 days earlier in her left eye combined with an anaphylactoid reaction. The patient was administered intravenous ceftriaxone (2 g / day) 9 times for 14 days due to aggravation of chronic osteomyelitis on her left ankle. There were no adverse events until the 7th intravenous ceftriaxone administration. However, anaphylactoid reactions occurred shortly after the 8th and 9th administration. On the 1st visit, her best corrected visual acuity in the right eye was 1.0, and in the left eye 0.1. On fundus examination, retinal hemorrhages and perivascular sheathing were observed in the superonasal area in the right eye and in the entire retina in the left eye. Anterior chamber cell reactions were not noted on slit lamp examination, and vitritis was absent in both eyes. Laboratory data showed no conclusive evidence of autoimmune or origin of infection. On the last visit, 25 months after the initial visit, the patient's best corrected visual acuity was 0.02 in the left eye and visual acuity and fundus appearance were normal in the right eye. CONCLUSIONS: Bilateral occlusive retinal vasculitis may be associated with intravenous ceftriaxone injection, and immunological and serological tests should be performed thoroughly along with history taking to clarify the cause of retinal vasculitis.

Axial Length Change after Implantable Collamer Lens Implantation

PURPOSE: The axial length measurement is an important variable in calculating the intraocular lens (IOL) power in cataract surgery. In this study, the effects of the implantable collamer lens (ICL) on the axial length measurement were investigated. METHODS: The axial lengths of 141 eyes of 76 highly myopic patients were measured before ICL implantation and 1 month postoperatively using applanation A-scan ultrasound. RESULTS: The measured axial lengths before ICL implantation and 1 month after the surgery were 28.03 +/- 1.91 mm and 28.08 +/- 1.86 mm respectively, with a statistically significant difference of 0.05 mm (p = 0.036). These 2 values showed a high correlation (R2 = 0.9829, p < 0.0001). CONCLUSIONS: Even though the axial length after ICL implantation significantly increased, the 0.05 mm change was too small to influence the determination of the IOL diopters in cataract surgery. Therefore, ICL implantation history may be reflected when measuring the axial length for the IOL power calculation in cataract surgery, but the axial length measured immediately before the cataract surgery may be used to calculate the IOL power regardless of the ICL implantation history.