Comparison of clinical efficacy and stability of Toric implantable collamer lens implantation in different orientations / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the clinical efficacy, vault, and rotational stability of horizontal, oblique, and vertical implantation of Toric implantable collamer lens(TICL).METHODS: Retrospective cohort study. A total of 92 cases(120 eyes)who underwent TICL implantation from July 2018 to March 2022 and had regular follow-up for at least 1 a postoperatively(1 d, 1 wk, 1, 3, 6 mo, and 1 a)at Wuhan Bright Eye Hospital were collected. The patients were divided into three groups, with 34 cases(45 eyes)in horizontal implantation group, 25 cases(29 eyes)in oblique implantation group(29 cases), and 33 cases(46 eyes)in vertical implantation group. Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), diopters, vault, and rotation angle(deviation of the actual axis of TICL from the expected axis).RESULTS: All surgeries were uneventful, and there were no complications such as infection, secondary glaucoma, or cataract opacity. Safety and efficacy of the surgery: the CDVA of the three groups of patients was better than or equal to the preoperative CDVA at 1 a postoperatively, and there was no statistically significant differences in postoperative UDVA and CDVA of the three groups(P>0.05). The safety index at 1a postoperatively was 1.34±0.21, 1.34±0.17, and 1.31±0.18 for the horizontal, oblique, and vertical groups, respectively. The efficacy index was 1.26±0.21, 1.33±0.18, and 1.27±0.16 for the three groups, respectively, both with no statistically significant differences(P>0.05). Vault: there was a significant difference in postoperative vault among the three groups(P=0.003), with the vertical group having the lowest vault, followed by the horizontal group and the oblique group. The vaults at different follow-up time points within each group showed significant differences(P<0.001), and all decreased over time. Residual astigmatism: there was no significant difference in residual astigmatism among the three groups(P=0.130), but there were differences at different follow-up time points within each group(P<0.001). Rotation angle: no significant differences in rotation angle were observed among the three groups(P=0.135), but there were differences at different follow-up time points within each group(P<0.001).CONCLUSION: The implantation of TICL in different orientations has good safety and efficacy, the postoperative rotational stability is good, and the appropriate angle can be selected to implant TICL according to the clinical situation.

Vector analysis of toric implantable collamer lens V4c implantation in correcting moderate to high myopia with high astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effect of toric implantable collamer lens(TICL)V4c for correcting moderate to high myopia with high astigmatism using vector analysis and quality of life impact of refractive correction(QIRC).METHODS: Retrospective case series. A total of 55 patients(90 eyes)with moderate to high myopia and high astigmatism who received TICL V4c implantation in the refraction surgery center of ophthalmology department in our hospital from January 2019 to December 2022 were collected. Followed-up for 1 a, the uncorrected distance visual acuity(UDVA), best corrected visual acuity(BCVA)and diopters were observed. Alpins vector analysis was used to evaluate the effect of astigmatism correction, and QIRC scale was used to evaluate patients' quality of life.RESULTS: At 1 a postoperatively, the UDVA of 98% eyes was the same or better than pre-operative BCVA, the safety index was 1.11±0.14, and the efficacy index was 1.11±0.15. The angle of error of 97% of the astigmatic eyes was within ±15°. The results of vector analysis showed that correction index was 0.83±0.13, angle of error was 1.00±4.49°, and index of success was 0.21±0.15. The total higher order aberrations under a pupil diameter of 6 mm was significantly increased compared with preoperatively(P<0.05), the QIRC score was significantly better than that before surgery(P<0.001), and the increase of total QIRC scores was positively correlated with preoperative spherical equivalent(rs=0.215, P<0.05), indicating that the higher degree of myopia before surgery the patients, the better the quality of life after TICL implantation.CONCLUSION: TICL V4c implantation for the correction of moderate to high myopia with high astigmatism is safe and effective, and the patients' quality of life significantly improved after surgery.

Comparison of clinical effects of corneal topography-guided FS-LASIK and TICL implantation for myopia with moderate to high astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the clinical efficacy of the myopic with moderate to high astigmatism correction between corneal topography-guided femtosecond laser in situ keratomileusis(FS-LAISK)and Toric implantable collamer lens(TICL).METHODS: A total of 60 patients(115 eyes)with moderate to high astigmatism in myopia(115 eyes)from June 2019 to June 2021 and treated in the refractive center of Heyuan Aier Eye Hospital were enrolled in the study, then were divided into Group A and Group B according to the operations they would accept. There were 32 patients(62 eyes)in the Group A treated with corneal topography-guided FS-LASIK and 28 patients(53 eyes)in the Group B treated with TICL implantation. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical diopter and residual astigmatism were recorded preoperatively and postoperatively at 3mo, surgical safety and efficacy were evaluated, and the Alpins vector analysis was used to evaluate the astigmatism.RESULTS: The postoperative at 3mo, there were no differences in the safety index(1.163±0.167 vs 1.136±0.194)and the efficacy index(1.145±0.159 vs 1.123±0.196)between the patients of the two groups(P>0.05). However, the astigmatism vector analysis showed that there were statistically differences in the index of success index [0.125(0.091, 0.200)vs 0.200(0.167, 0.250)], the correction index [1.000(0.902, 1.066)vs 0.834(0.783, 0.869)] and the flattening index [1.000(0.922, 1.079)vs 0.835(0.795, 0.870)](P<0.01).CONCLUSION:Corneal topography-guided FS-LASIK and TICL implantation were effective and safe in correcting myopia with moderate to high astigmatism, and corneal topography-guided FS-LASIK perform better than TICL implantation for the astigmatism correction.

Clinical efficacy of Toric ICL implantation and its effect on corneal astigmatism and aberration / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the refractive outcomes and changes of corneal astigmatism and higher-order aberrations(HOAs)after Toric implantable Collamer lens implantation(Toric ICL).<p>METHODS: Prospective nonrandomized clinical trial studies. This study included 102 eyes of 57 patients underwent Toric ICL for myopic astigmatism correction. Uncorrected visual acuity(UCVA), manifest refraction, best spectacle-corrected visual acuity(BSCVA), manifest refractive cylinder, the corneal astigmatism and HOAs were measured preoperatively and up to 6mo after surgery. The vectors were measured using corneal topography, the Pentacam HR system and Wavefront analyzer.<p>RESULTS:Postoperative, the percentage of eyes had a spherical equivalent refraction within -1.00 D were 93.80%. The percentage of eyes within -0.50 D of emmetropia were 85.30%. The percentage of eyes which postoperative UCVA ≥20/25 was 66.30% and the percentage of eyes which postoperative UCVA ≥20/20 was 65.50%. The corneal astigmatism and aberrations preoperatively showed no statistical significance compared with postoperative. The total eyes aberrations and coma resulted in slight changes and had no statistically significant.<p>CONCLUSION:The corneal incision of Toric ICL implantation caused no changes in astigmatism and higher-order wavefront aberrations of cornea.

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

PURPOSE: To evaluate the clinical outcomes of implantable collamer lens (ICL) implantation with simultaneous full thickness astigmatic 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), refractive 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 moderate to high myopic astigmatism.

Toric posterior chamber phakic intraocular lenses implantation for moderate high myopic astigmatism / 重庆医学

Objective To evaluate efficacy ,stability and safety after implantation of toric implantable collamer lens (TICL) to correct moderate to high myopic astigmatism .Methods This study evaluated 125 eyes of 71 patients with moderate to high myopic astigmatism who accepted TICL implantation .LogMAR uncorrected(UCVA) and best corrected(BCVA) visual acuity ,intraocular pressure ,cycloplegic refraction and manifest refraction examination were assessed preoperatively on 3 ,6 ,12 months postoperatively . The rotation of TICL axis were measured on 3 ,6 ,12 months postoperatively .Results 12 months postoperatively ,the logarithm of the minimum angle of resolution(LogMAR) UCVA were 0 .064 ± 0 .157 which were remarkably better than preoperative BCVA (P<0 .01) .119 eyes(95 .2% ) had postoperative UCVA better than or equal to preoperative BCVA .The manifest spherical refrac‐tion(absolute value) was (0 .36 ± 0 .41)D .105 (84 .0% ) eyes were within ± 0 .5 D .The mean manifest refractive cylinder was (-0 .63 ± 0 .61)D .109(87 .2% ) eyes had ≤ -1 .00 D .The mean rotation on 12 months postoperatively was (4 .76 ± 6 .14)° .The rotation of 101(80 .8% ) eyes were within 5 degrees .No vision threatening complications occurred during the observation period . Conclusion Implantation of TICL is safe and stable in the treatment of moderate to high myopic astigmatism .TICL is an ideal sur‐gical option to treat moderate to high myopic astigmatism .

Toric implantable collamer lens for keratoconus.

Keratoconus is a progressive non-inflammatory thinning of the cornea that induces myopia and irregular astigmatism and decreases the quality of vision due to monocular diplopia, halos, or ghost images. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have been implanted toric posterior chamber phakic intraocular lenses (PC pIOLs) alone or combined with other surgical procedures to correct the refractive errors associated with keratoconus as an off label procedure with special informed consent from the patients. Several reports attest to the safety and efficacy of the procedure, though the associated corneal higher order aberrations would have an impact on the final visual quality.

Partial Visual Rehabilitation Using a Toric Implantable Collamer Lens in a Patient with Keratoconus: A Case Report with 20 Months of Follow-up

We report the case of a 37-year-old man with a high myopic keratoconus eye that was treated with a posterior chamber toric implantable collamer lens (ICL) in Korea. The patient had a history of contact lens intolerance and did not want to have a corneal transplantation. His uncorrected visual acuity (UCVA) and best spectacle corrected visual acuity were 0.02 and 0.4 in the left eye, respectively. Preoperatively, the manifest refraction was -12.0 -3.5 x 30A. Postoperatively, the manifest refraction was -1.75 x 180A. UCVA improved markedly after implantation. No intraoperative or postoperative complications were observed during 20 months of follow-up. Toric ICL implantation may be a possible alternative surgical option for the visual rehabilitation of high myopic astigmatism in keratoconus patients with rigid gas permeable contact lens intolerance and in patients who do not want to get a corneal transplant.

Totic Implantable Collamer Lens for extreme high myopic astigmatism / 中华实验眼科杂志

Background In recent years,with the contiunous progress of the refractive surgery,the operation skill of phakic intraocular lens(PIOL)implantation for correcting extreme high myopia,astigmatism,farsightedness have made greater progression,and its security,effectiveness in clinical attract much more attention. Objective This study was to evaluate the efficacy,safety and stability of Toric Implantable Collamer Lens(TICL)for extreme high myopic astigmatism. Methods This retrospective case series included 33 eyes of 27 patients from May 2008 to February 2009.A TICL was intraocularly implanted via a 3 mm clear corneal incision after paraocular anesthesia.Patients were examined preoperatively and followed-up at 1 day,1 week,1 month,3,6,12 and 18 months postoperatively.The examinations included uncorrected visual acuity,best corrected visual acuity(BCVA),slit lamp examination,refraction,intraocular pressure,endothelial cell morphometry,etc.The written informed consent was obtained from each patient before any medical procedure. Results The uncorrected visual acuity in 96.97% eyes was equal or improved after operation in comparison with BCVA of preoperation.The spherical refraction was within-1.00 D-+0.25 D.The cylinder refraction was within-1.00 D-0 D.The axial deviation of TICL within 10 degree was 93.94%(31/33).No significant differences were found in the intraocular pressure and endothelial cell morphometry between preoperation and postoperation(intraocular pressure:F=3.35,P=5.49;endothelial cell morphometry:t=1.835,P=0.082).The visual acuity and refraction were stable during the follow-up.Astigmatic axial rotation required surgical intervention on one eye.One eye occurred high intraocular pressure because of bigger TICL diameter.The intraocular pressure returned to normal after TICL was exchanged.No cataract occurred during the follow-up duration. Conclusion TICL implantation appears to be an effective,safe and reliable method for extreme high myopic astigmatism.

Clinical Outcomes of Toric Implantable Collamer Lens implantation

PURPOSE: To assess the efficacy of the Toric Implantable Collamer Lens (Toric ICL) to treat moderate to high myopic astigmatism. METHODS: Toric ICL was implanted in 77 eyes of 40 patients with myopia (spherical equivalent [SE] between 3.5 and 18.5 diopters [D]) and astigmatism between 1 and 6 D. The patients were followed up for at least 3 months. Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, and postoperative complications were evaluated. RESULTS: At 3months postoperatively, the proportion of eyes with 1.0 or better UCVA (56 eyes out of 77 eyes, 72.7%) was significantly greater than the proportion of eyes with preoperative 1.0 or better BSCVA (38 eyes out of 77 eyes, 49.4%). The mean manifest refractive cylinder dropped from 2.78D (+/-1.05) at baseline to 0.35D (+/-0.34) postoperatively, an 87.4% decrease in astigmatism. Mean manifest refraction SE (MRSE) improved from -9.93D (+/-2.66) preoperatively to 0.15D (+/-0.33) postoperatively. A total of 96.1% of eyes were predicted accurately to within +/-0.75D of predicted MRSE. Mean improvement in BSCVA was 0.79lines; there were no eyes that lost two lines of BSCVA after 3 months postoperatively. CONCLUSIONS: The results support the efficacy and predictability of Toric ICL implantation to treat moderate to high myopic astigmatism.