Dynamic assessment of variations in pupil diameter using swept-source anterior segment optical coherence tomography after phakic collamer lens implantation.

PURPOSE: To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens (ICL, STAAR Surgical) with a central port. METHODS: This prospective, observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant. A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery. RESULTS: Preoperative mean pupil size under photopic conditions was 3.38 ± 0.64 mm; after surgery, this increased to 3.48 ± 0.61 mm. Mean pupil size under scotopic light conditions was 5.72 ± 0.79 mm before surgery and 5.84 ± 0.77 mm postoperatively. The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10 ± 0.44 mm (P = 0.078) and 0.12 ± 0.58 mm (P = 0.098), respectively. The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes (60%). The mean central vault value was 412 ± 177 µm under maximum miosis and 506 ± 190 µm under maximum mydriasis. We found a positive correlation between vault and differences in pupil diameter under all light conditions (P < 0.05). CONCLUSION: Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane. The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault.

PURPOSE: To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. SETTING: Clinica Baviera, Madrid, Spain. DESIGN: Retrospective cross-sectional single-center study. METHODS: Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 µm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. RESULTS: The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 µm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 µm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. CONCLUSIONS: Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Determining the Potential Role of Crystalline Lens Rise in Vaulting in Posterior Chamber Phakic Collamer Lens Surgery for Correction of Myopia.

PURPOSE: To assess the effect of crystalline lens rise (CLR) on postoperative vault in eyes implanted with a phakic Visian Implantable Collamer Lens (ICL) (STAAR Surgical Company, Monrovia, CA) with a central port for myopic correction. METHODS: Non-invasive Fourier-domain swept-source anterior segment optical coherence tomography was used for dynamic assessment of the study eyes under changing light conditions. Phakic intraocular lens (IOL) vault, anterior chamber depth (ACD), and CLR were recorded after surgery, and intra-eye differences were analyzed under scotopic and photopic ambient light conditions. Inter-group analysis and regression analysis were performed to investigate any potential correlation between these biometric variables. RESULTS: This retrospective observational study comprised 111 eyes (65 patients) implanted with a myopic Visian ICL. The mean change in CLR from mydriasis to miosis was 59 ± 60 µm (P < .001). The sample was further divided into four groups according to the CLR value in miosis: CLR < 0, 0 to 200, 201 to 350, and > 350 µm. A significant difference in central vault values was observed between the < 0 and > 350 µm groups, the 0 to 200 and 201 to 350 µm groups, and the 0 to 200 and > 350 µm groups (P < .05). Eyes with a high vault value (> 750 µm in mydriasis) had lower CLR values (P < .001) and higher ACD values (P < .001) than eyes with a low vault value (< 100 µm in miosis). The linear correlation observed was negative between CLR and ACD, positive between postoperative vault and ACD, and negative between postoperative vault and CLR (P < .001). CONCLUSIONS: CLR significantly affected anterior chamber depth and postoperative ICL vault. [J Refract Surg. 2019;35(3):177-183.].

Dynamic Assessment of Light-Induced Vaulting Changes of Implantable Collamer Lens With Central Port by Swept-Source OCT: Pilot Study.

PURPOSE: To assess dynamic variations in vault induced by changes in brightness in eyes implanted with phakic collamer intraocular lens (pIOL) with central port for correction of myopia, defining new parameters of vaulting measurement. METHODS: We used a noninvasive Fourier-domain swept-source anterior-segment optical coherence tomography (AS-OCT) system to dynamically evaluate the shifts between the pIOL and anterior chamber structures under changing light conditions. For each eye assessed, we measured vault interval (VI), which we define based on central vault values in maximum mydriasis and in maximum miosis after light-induced changes in pupil diameter, and vault range (VR), which we define as the absolute difference between the VI values. RESULTS: The pilot study sample comprised 39 eyes (23 patients) previously implanted (mean 107 ± 156 days) with a pIOL. A significant difference in vault value was found when maximum and minimum pupil size was assessed under changing external light conditions (P < 0.001). The mean VR from scotopic (0.5 lux) to photopic (18,500 lux) light conditions was 167 ± 70 µm. CONCLUSIONS: Vault is continuously affected during movements of the pupil induced by external luminance. TRANSLATIONAL RELEVANCE: Quantifiable dynamic parameters VR and VI obtained with this AS-OCT device describe the position of the pIOL in the posterior chamber of the eye in a more accurate and real way than static vault measurements, and may contribute to improved understanding of the behavior of the pIOL in terms of safety.

Optical Coherence Tomography in Children With Microtropia.

PURPOSE: To assess whether optical coherence tomography (OCT) could be useful for detecting and documenting fixation in patients with microtropia. METHODS: Retinal fixation observation was performed using spectral-domain OCT on amblyopic children with microtropia. The position between the retinal fixation point and the anatomical fovea was measured, in microns, using the system software tools. Only patients with a high level of cooperation, OCT scan quality signal of 7 or better, and visual acuity of 0.70 logarithm of the minimum angle of resolution (logMAR) or worse in the amblyopic eye were included. RESULTS: A total of 25 patients were included: 15 with microtropia (study group) and 10 without tropia and with foveal fixation and stereopsis (control group). In the study group, microtropia was previously diagnosed in 67% of cases through the cover test, and was predominantly in the left eye (73%). The average visual acuity of the sound eye was 0.03 decimal and 0.18 logMAR in the amblyopic eye. The microtropia was 3.73 ± 3.34 prism diopters and eccentric fixation (387 ± 199 µm) with OCT was observed in all cases except one. Eccentricity was predominantly in the superonasal quadrant (57%). Both eyes in the control group and the contralateral eyes of the study group showed foveal fixation. CONCLUSIONS: OCT can play an important role in the diagnosis and measurement of eccentric fixation in eyes with microtropia, providing high sensitivity. [J Pediatr Ophthalmol Strabismus. 2018;55(3):171-177.].

Pupillary block glaucoma secondary to central port occlusion following insertion of a phakic implantable copolymer lens.

A 28-year-old woman had uneventful implantation of a phakic intraocular lens (pIOL) in her left eye (Visian ICL, EVO+ model, 13.2, -7.50 diopters) to correct myopia. Six days after the procedure, she presented with herniation of the iris. Surgical reduction was carried out successfully through the previous peripheral corneal paracentesis. On the following day, the patient reported ocular pain and blurry vision. Examination showed a shallow anterior chamber, moderate diffuse corneal edema, and ocular hypertension. The central port of the pIOL was blocked by iris pigment. The condition resolved completely after surgical iridectomy, and the postoperative course was uneventful. To our knowledge, this is the first reported case of pupillary block after implantation of a pIOL with a central hole. This uncommon complication should be taken into consideration when the iris is manipulated excessively after pIOL insertion.

Validation of the Spanish Catquest-9SF in patients with a monofocal or trifocal intraocular lens.

PURPOSE: To validate the Spanish Catquest-9SF and study patient-reported visual function after implantation of a trifocal versus a monofocal intraocular lens (IOL). SETTING: Clinica Baviera, Valencia and Madrid, Spain. DESIGN: Prospective case series. METHODS: The Catquest-9SF was translated from English to Spanish according to a standard procedure. The Spanish version was validated through Rasch analysis. Patients completed the Catquest-9SF before cataract surgery and 3 months after the surgery. The change in patient-reported visual function caused by surgery, the level of achieved visual function, and satisfaction with vision after surgery were assessed for bilaterally implanted trifocal IOLs versus monofocal IOLs. RESULTS: The Spanish Catquest-9SF showed very good psychometric properties. Patient-reported achieved visual function was significantly better for those with a trifocal IOL than for those with a monofocal IOL (P < .001). This was also true when the groups were matched for age and ocular comorbidity (P = .006). In multivariate analyses of all cases and matched cases (the same age and no comorbidity), the reported visual function was significantly better with trifocal IOLs than with monofocal IOLs (P = .001 and P = .008, respectively). There was greater improvement after trifocal IOL implantation in the matched cases, although not significant (P = .103). CONCLUSIONS: Results show the Spanish version of Catquest-9SF is a valid patient questionnaire with good psychometric properties. Patients with a trifocal IOL implanted bilaterally reported better visual function than those with a monofocal IOL implanted bilaterally. The change in visual function after surgery was also greater in patients with a trifocal IOL. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Visual outcomes in adult amblyopic eyes with moderate myopia after corneal laser surgery versus copolymer phakic intraocular lens implant.

PURPOSE: To assess visual acuity and refractive correction in moderately myopic adult eyes with suboptimal preoperative corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) or insertion of a posterior chamber Implantable Collamer Lens phakic intraocular lens (pIOL). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Torrevieja Hospital, Madrid, Spain. DESIGN: Retrospective study. METHODS: The study sample included 1310 eyes that had LASIK and 94 that had insertion of a pIOL from July 2002 to September 2013. Suboptimal preoperative CDVA was defined as equal to logMAR 0.15 or below and moderate myopia as a spherical equivalent of -5.0 to -10.0 diopters (D). RESULTS: The preoperative mean CDVA was 0.22 logMAR ± 0.09 (SD) in the LASIK group and 0.23 ± 0.09 logMAR in the pIOL group. Postoperative uncorrected distance visual acuity (UDVA) was 0.13 ± 0.12 logMAR in the laser group and 0.12 ± 0.09 logMAR in the pIOL group, with a postoperative CDVA of 0.11 ± 0.10 logMAR and 0.08 ± 0.07 logMAR, respectively. CONCLUSIONS: Compared with preoperative values, amblyopic eyes with moderate myopia having LASIK or implantation of a pIOL demonstrated a statistically significant improvement in UDVA and CDVA (P < .001). The pIOL group performed significantly better than the LASIK group in terms of safety and efficiency. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intraocular pressure during the early postoperative period after 100 consecutive implantations of posterior chamber phakic intraocular lenses with a central hole.

PURPOSE: To study changes in intraocular pressure (IOP) during the early postoperative period in eyes having implantation of a posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens V4c). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. DESIGN: Case series. METHODS: This retrospective review included the first consecutive eyes having implantation of a spherical or toric myopic pIOL with a central hole at Clínica Baviera from December 2011 to June 2012 by the same experienced surgeon. The IOP was evaluated preoperatively and 1 day, 1 week, and 1 month postoperatively. RESULTS: The study comprised 100 eyes. The mean IOP changed from 14.6 mm Hg ± 3.4 (SD) (range 8 to 26 mm Hg) preoperatively to 14.5 ± 4.6 mm Hg (range 6 to 30 mm Hg) 1 day postoperatively, 14.2 ± 4.2 mm Hg (range 6 to 29 mm Hg) at 1 week, and 12.3 ± 3.4 mm Hg (range 9 to 24 mm Hg) at 1 month. No statistically significant changes were detected over time postoperatively (P>.2). No perioperative complications associated with the implantation of the pIOL were recorded. No pIOLs were explanted, no toric pIOL rotation was detected, and no pupillary block or acute angle closure was observed. CONCLUSION: The short-term clinical data for the new pIOL model with the central hole (KS-Aquaport) suggest that it is a safe and effective means for controlling postoperative IOP.