ICL Implants an Option for Residual Myopia Following Refractive Surgery

Implantation of an implantable collamer lens (ICL) in eyes with myopic regression following primary laser vision correction surgery appears to be safe and effective, according to research published in BMC Ophthalmology.

After undergoing a corneal refractive procedure and achieving the desired effect for a period, some patients may experience new changes to their refractive status, referred to as ‘myopic regression.’ These residual refractive errors that persist or return after laser vision correction surgery is the most common cause of postoperative dissatisfaction, the researchers report. However, ICLs have the potential to restore the original procedure’s desired effect, the study suggests.

The investigators evaluated a retrospective case series to analyze the surgical outcomes of ICL implantation in eyes with myopic regression after undergoing a primary laser vision correction surgery. The original procedures included photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK).

A total of 30 eyes of 17 patients (mean age 35 years, 73% women) who had a history of laser vision correction surgery and later underwent ICL implantation were included in the study. Prior to ICL implantation, most eyes (21/30) had PRK, while the remaining eyes had LASIK (9/30). The average time interval between prior surgery and ICL implantation was 73.27 months (range, 61–84). The researchers evaluated visual acuity and refractive error preoperatively and 3-months postoperatively to calculate efficacy and safety indices. 

At 3-months postoperative, patients had a mean uncorrected distance visual acuity (UCVA) of -0.03±0.11 logMAR, corrected distance visual acuity (CDVA) of -0.04±0.09 logMAR, and spherical equivalent of -0.06±0.33 D. The investigators found that the 3-month Snellen UCVA was better than 20/20 for 83% of eyes, and they saw that 97% of eyes were unchanged or had improved CDVA following surgery. 

The investigators estimated the mean efficacy index (defined as the ratio of postoperative UDVA to preoperative CDVA) as 1.11±0.22 and the safety index (defined as the ratio of postoperative CDVA to preoperative CDVA) index as 1.13±0.20. They also observed that the majority of eyes, 93% and 100%, were within ±0.5 D and ±1.0 D, respectively, of the targeted spherical equivalent refraction. No intraoperative and postoperative complications were observed in any of the cases.

“ICL implantation showed safe, effective, and predictable postoperative outcomes in eyes with myopic regression,” the investigators report. “ICL implantation can be considered as an appropriate option to treat myopic regression after LVC surgery.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Chung B, Kim JH, Kang DSY, et al. 3-month surgical outcomes of implantable collamer lens implantation for myopic regression after laser vision correction surgeries: a retrospective case series. BMC Ophthalmol. Published November 16, 2021. doi:10.1186/s12886-021-02163-3