Abstract
Background
To evaluate the 3-year clinical outcomes after toric implantable collamer lens (ICL) implantation for the management of moderate to high myopic astigmatism.
Methods
Thirty-four eyes of 20 patients who underwent toric ICL implantation were reviewed. All eyes completed 3-year follow-up. Uncorrected (UDVA) and corrected (CDVA) distance LogMAR visual acuities, refraction, endothelial cell density (ECD), and surgical complications were evaluated. Vectorial analysis of astigmatic correction was also done.
Results
A significant improvement in UDVA, CDVA, manifest spherical and cylindrical refraction was observed at 1 week and remained stable after 3 years. Twenty-six eyes (76.5 %) gained lines of CDVA, and two eyes (5.9 %) showed a loss of 1 line of CDVA. The spherical equivalent (SE) was within ±0.50 D of emmetropia in 18 eyes (52.9 %) and within ±1.00 D in 28 eyes (82.4 %). Differences between target-induced astigmatism (TIA) and surgically-induced astigmatism (SIA) were statistically significant (p < 0.01), and a trend to undercorrection of the refractive astigmatism was present after 3 years. The magnitude of flattening effect (FE) was found to be significantly lower than the magnitude of TIA (p < 0.01). The magnitude of the torque vector was always positive, with a value below 0.50 D in all cases. No vision-threatening complications were observed during the follow-up.
Conclusion
Toric ICL implantation is an effective and safe surgical option that provides a relatively predictable and stable refractive correction of myopic astigmatism. Further improvements are needed to minimize the degree of undercorrection.
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References
Kwitko ML, Jovkar S, Yan H, Rymer S (1996) Arcuate keratotomy to correct naturally occurring astigmatism. J Cataract Refract Surg 22:1439–1442
Müller Jensen K, Fischer P, Siepe U (1999) Sutureless corneal cataract surgery. Limbal release incisions for correcting astigmatism. Ophthalmologe 96:432–436
Arbelaez MC, Vidal C, Arba-Mosquera S (2009) Excimer laser correction of moderate to high astigmatism with a non-wavefront-guided aberration-free ablation profile: six-month results. J Cataract Refract Surg 35:1789–1798
Seiler T, Koufala K, Richter G (1998) Iatrogenic keratectasia after laser in situ keratomileusis. J Refract Surg 14:312–317
Stulting RD, Carr JD, Thompson KP, Waring GO 3rd, Wiley WM, Walker JG (1999) Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology 106:13
Malecaze FJ, Hulin H, Bierer P, Fournié P, Grandjean H, Thalamas C, Guell JL (2002) A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and Artisan phakic lens. Ophthalmology 109:1622–1630
Kamiya K, Shimizu K, Igarashi A, Komatsu M (2008) Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism. J Cataract Refract Surg 34:1687–1693
Sanders DR, Schneider D, Martin R, Brown D, Dulaney D, Vukich J, Slade S, Schallhorn S (2007) Toric implantable collamer lens for moderate to high myopic astigmatism. Ophthalmology 114:54–61
Dick HB, Alió J, Bianchetti M, Budo C, Christiaans BJ, El-Danasoury MA, Güell JL, Krumeich J, Landesz M, Loureiro F, Luyten GP, Marinho A, Rahhal MS, Schwenn O, Spirig R, Thomann U, Venter J (2003) Toric phakic intraocular lens: European multicenter study. Ophthalmology 110:150–162
Gimbel HV, Ziémba SL (2002) Management of myopic astigmatism with phakic intraocular lens implantation. J Cataract Refract Surg 28:883–886
Alpins NA (2001) Astigmatism analysis by the Alpins method. J Cataract Refract Surg 27:31–49
Alpins NA (1993) A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg 19:524–533
Alpins NA (1997) Vector analysis of astigmatism changes by flattening, steepening, and torque. J Cataract Refract Surg 23:1503–1514
Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13:388–391
Elies D, Alonso T, Puig J, Gris O, Güell JL, Coret A (2010) Visian toric implantable collamer lens for correction of compound myopic astigmatism. J Refract Surg 26:251–258
Bhikoo R, Rayner S, Gray T (2010) Toric implantable collamer lens for patients with moderate to severe myopic astigmatism: 12-month follow-up. Clin Exp Ophthalmol 38:467–474
Alió JL, Ortiz D, Abdelrahman A, de Luca A (2007) Optical analysis of visual improvement after correction of anisometropic amblyopia with a phakic intraocular lens in adult patients. Ophthalmology 114:643–647
Alfonso JF, Baamonde B, Fernández-Vega L, Fernandes P, González-Méijome JM, Montés-Micó R (2011) Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia: five-year follow-up. J Cataract Refract Surg 37:873–880
Kamiya K, Shimizu K, Aizawa D, Igarashi A, Komatsu M, Nakamura A (2010) One-year follow-up of posterior chamber toric phakic intraocular lens implantation for moderate to high myopic astigmatism. Ophthalmology 117:2287–2294
Chang JS, Meau AY (2007) Visian Collamer phakic intraocular lens in high myopic Asian eyes. J Refract Surg 23:17–25
Schallhorn S, Tanzer D, Sanders DR, Sanders ML (2007) Randomized prospective comparison of visian toric implantable collamer lens and conventional photorefractive keratectomy for moderate to high myopic astigmatism. J Refract Surg 23:853–867
Kamiya K, Shimizu K, Igarashi A, Hikita F, Komatsu M (2009) Four-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia. Arch Ophthalmol 127:845–850
Sanders DR, Doney K, Poco M, ICL in Treatment of Myopia Study Group (2004) United States Food and Drug Administration clinical trial of the Implantable Collamer Lens (ICL) for moderate to high myopia: three-year follow-up. Ophthalmology 111:1683–1692
Alpins NA, Goggin M (2004) Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery. Surv Ophthalmol 49:109–122
Lee SY, Kwon HJ, Ahn HS, Seo KY, Kim EK, Kim TI (2011) Comparison of patient outcomes after implantation of Visian toric implantable collamer lens and iris-fixated toric phakic intraocular lens. Eye (Lond) 25:1409–1417
Alfonso JF, Lisa C, Abdelhamid A, Montes-Mico R, Poo-Lopez A, Ferrer-Blasco T (2009) Posterior chamber phakic intraocular lenses after penetrating keratoplasty. J Cataract Refract Surg 35:1166–1173
Kamiya K, Shimizu K, Aizawa D, Igarashi A, Komatsu M (2009) Surgically induced astigmatism after posterior chamber phakic intraocular lens implantation. Br J Ophthalmol 93:1648–1651
Visser N, Berendschot TT, Bauer NJ, Nuijts RM (2012) Vector analysis of corneal and refractive astigmatism changes following toric pseudophakic and toric phakic intraocular lens implantation. Invest Ophthalmol Vis Sci 53:1865–1873
Baumeister M, Bühren J, Kohnen T (2004) Position of angle-supported, iris-fixated, and ciliary sulcus-implanted myopic phakic intraocular lenses evaluated by Scheimpflug photography. Am J Ophthalmol 138:723–731
Apple DJ, Werner L (2001) Complications of cataract and refractive surgery: a clinicopathological documentation. Trans Am Ophthalmol Soc 99:95–107, discussion, 107–109
Zaldivar R, Davidorf JM, Oscherow S, Ricur G, Piezzi V (1999) Combined posterior chamber phakic intraocular lens and laser in situ keratomileusis: bioptics for extreme myopia. J Refract Surg 15:299–308
Chang J, Lau S (2009) Toric implantable collamer lens for high myopic astigmatic Asian eyes. Ophthalmology 116:2340–2347
Alfonso JF, Fernández-Vega L, Fernandes P, González-Méijome JM, Montés-Micó R (2010) Collagen copolymer toric posterior chamber phakic intraocular lens for myopic astigmatism: one-year follow-up. J Cataract Refract Surg 36:568–576
Jiménez-Alfaro I, Benítez del Castillo JM, García-Feijoó J, Gil de Bernabé JG, Serrano de La Iglesia JM (2001) Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation. Ophthalmology 108:90–99
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The authors have no financial or proprietary interest in any product, method, or material described herein.
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All the authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data of the current study if requested.
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Sari, E.S., Pinero, D.P., Kubaloglu, A. et al. Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up. Graefes Arch Clin Exp Ophthalmol 251, 1413–1422 (2013). https://doi.org/10.1007/s00417-012-2172-8
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DOI: https://doi.org/10.1007/s00417-012-2172-8