ICL Implantation for More Myopes

Implantable collamer posterior chamber phakic refractive lenses deliver impressive visual outcomes with a high degree of safety for myopic patients, according to a long-term retrospective study presented by Milad Modabber MD at the ESCRS Winter Meeting in Frankfurt.

“Our study demonstrates the safety and efficacy of implantable collamer lens (ICL) surgery for both low and high myopia,” Dr Modabber said. “Notably, ICL implantation was associated with significant improvements in best-corrected visual acuity (BCVA), particularly with increasing degrees of myopia.”

The retrospective study included a total of 1,332 eyes implanted with EVO or EVO+ ICLs (STAAR Surgical) between 2016 and 2023 for the correction of low, intermediate, and high degrees of myopia with or without astigmatism. All surgeries were uneventful, and 71% of the implanted ICLs were toric lenses to correct astigmatism greater than 1.0 D.

Discussing the results, Dr Modabber said the uncorrected distance visual acuity (UDVA) at the last follow-up appointment was very good for all patients, with a mean UDVA of 0.02 logMAR, 0.03 logMAR, and 0.05 logMAR for the low, intermediate, and high myopia groups respectively.

Significant reductions in manifest refraction spherical equivalent (MRSE) were observed in all myopia groups, with 97%, 96%, and 86% of eyes within 0.5 D of target refraction in the low, intermediate, and high myopic groups, respectively. The refractive outcomes were stable over the follow-up period. There was no change in corrected distance visual acuity (CDVA) at the last follow-up examination for 91%, 88%, and 86% of patients in the low, intermediate, and high myopic groups.

Efficacy and safety indices were favourable in all groups. There was no significant decrease in endothelial cell counts during the six-month follow-up period. The intraocular pressure was also stable, with Dr Modabber surmising that a temporary and mild postoperative rise in IOP seen in some patients after one week may be due to retained viscoelastic material.

Around 6% of patients required a secondary intervention, with laser enhancement in 40 patients (3%), ICL size adjustment in 26 patients (2%), and toric IOL rotation in 15 patients (1%).

“We had very low numbers of laser vision correction enhancements. Almost all of them were in the high myopia group, either because of refractive unpredictability or because those patients with extreme degrees of myopia (greater than -18.0 D) had been maximally corrected with ICL and then enhanced further with laser,” Dr Modabber explained. Explantation was required in a single patient (0.15%).

Summing up, Dr Modabber said the visual performance of ICL has been shown to be on a par or superior to wavefront-guided LASIK in low to moderate myopia.

“I think this is another area of evidence that shows ICL should not be reserved only for high degrees of myopia, as the lens performs extremely well across all degrees of myopia. This is particularly relevant bearing in mind all the limitations in corneal refractive procedures in thin corneas, irregular corneal topography, or pre-existing dry eye syndrome,” he said. “As the safety and acceptability of ICL increases, I feel we [will] continue to work down the dioptre curve and implant ICLs in ever smaller prescriptions, as deemed appropriate for a given patient.”

Milad Modabber MD, FRCSC is a cornea, cataract, and refractive surgeon at the Herzig Eye Institute, Toronto, Canada. mmodabber@herzig-eye.com