Original article
Effect of Accommodation on Vaulting and Movement of Posterior Chamber Phakic Lenses in Eyes With Implantable Collamer Lenses

https://doi.org/10.1016/j.ajo.2015.07.014Get rights and content

Purpose

To investigate and compare vaulting and movement changes during accommodation in eyes with the V4c and V4 implantable collamer lenses (ICL).

Design

Comparative, observational case series.

Methods

The medical records of 35 eyes (18 patients) with the V4 ICL and 51 eyes (26 patients) with the V4c ICL were retrospectively examined and included in analyses. Anterior chamber depth (ACD), posterior corneal surface–to–ICL distance (endo-ICL distance), pupil size, and postoperative vaulting were evaluated using the Visante anterior chamber optical coherence tomography system. Images were taken during the nonaccommodative and accommodative states 3 months after ICL implantation. Refractive error, keratometry values, axial length, intraocular pressure, and central corneal thickness were evaluated at 3 months postoperatively.

Results

ICL vaulting did not significantly change during accommodation in eyes with either the V4 or V4c ICL (P = .532 for V4 ICL and P = .415 for V4c ICL). However, significant reductions in ACD, endo-ICL distance, and pupil size were observed during accommodation in both groups. In eyes with a V4 ICL, the change in [Δ] ACD was 0.2 ± 0.1 mm (P < .001), Δendo-ICL distance was 0.2 ± 0.1 mm (P < .001), and Δpupil size was 0.5 ± 0.9 mm (P = .021). For eyes with the V4c ICL, ΔACD was 0.2 ± 0.2 mm (P < .001), Δendo-ICL distance was 0.2 ± 0.2 mm (P < .001), and Δpupil size was 0.8 ± 1.2 mm (P < .001). The mean reductions of each parameter were not statistically different between eyes with the V4 ICL and the V4c ICL.

Conclusions

Contrary to the light stimulation response, accommodation does not significantly affect ICL vaulting differently in eyes with either the V4 or V4C ICLs.

Section snippets

Design

This retrospective, comparative observational case series was performed with the approval of the Institutional Review Board of Yonsei University College of Medicine (Seoul, South Korea). All study conduct adhered to the tenets of the Declaration of Helsinki and followed good clinical practices. All patients provided written informed consent to allow their medical information to be included in study analyses.

Patients

Patients were included in analyses if they were older than 20 years of age and had

Results

A total of 86 eyes of 44 patients (32 women, 12 men) who underwent ICL implantation were ultimately included in analyses. All subjects were myopic and had a mean SE of −9.65 ± 2.42 D (range: −5.12 to −15.94 D). The V4 ICL was implanted into 35 eyes of 18 patients and the V4c ICL was implanted into 51 eyes of 26 patients. Table 1 summarizes patient demographic data and ocular characteristics before and 3 months after surgery. Mean ICL power was −13.0 ± 3.4 D (range, −7.0 to −22.0 D) in both

Discussion

We measured postoperative ICL vaulting, ACD, endo-ICL distance, and pupil size in both the nonaccommodative and accommodative states in eyes implanted with either the V4 or V4c ICL. No significant change in postoperative vaulting was found during accommodation within each ICL group. Additionally, vaulting was not significantly different between ICL groups in either the accommodative or nonaccommodative states. We did observe significant decreases in ACD, endo-ICL distance, and pupil size during

Hun Lee, MD, is currently Assistant professor of Department of Ophthalmology in Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, South Korea. He graduated from Yonsei University College of Medicine in 2006, where he completed his ophthalmology residency in 2011 and corneal fellowship in 2015. His research interests are visual quality and refractive error, including cataract and refractive surgery.

References (28)

Cited by (35)

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    Interestingly, those authors also found an increased lens thickness, shortening of the ACD, and a small pupil constriction, all of which may contribute to a decrease in vault, but also a forward movement of the ICL to the endothelium, which could counteract that decrease. Several studies have found similar changes in the ACD, pupil [11,15,16] and forward movement of the ICL [15,16], which led either to a non-significant decrease in vault [11,15] or no change [16]. Interestingly, as González-López et al. have reported, although the ICL vault has traditionally been considered a static parameter, it is in fact fully dynamic, varying continuously with the natural movements of the iris throughout the day [10].

  • A systematic review about the impact of phakic intraocular lenses on accommodation

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    This potential accommodative loss can be explained by two theories. From the optical point of view, biometric changes occurring during accommodation suggest that the power of the eye for a specific distance may be different from the expected if the optic eye system remains static and only lens power changes.21–25 Furthermore, the change in light vergence and the size of the retinal image evidenced by Langenbucher17 show that more accommodation is required to focus a near object with pIOLs compared to spectacles.

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Hun Lee, MD, is currently Assistant professor of Department of Ophthalmology in Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, South Korea. He graduated from Yonsei University College of Medicine in 2006, where he completed his ophthalmology residency in 2011 and corneal fellowship in 2015. His research interests are visual quality and refractive error, including cataract and refractive surgery.

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