More Than a Decade of Experience With Implantable Collamer Lens.

We read with great interest the article by Moya et al. in the August 2015 issue.1 The literature on longterm outcomes and complications of posterior chamber phakic intraocular lenses is scarce and the authors effectively describe their 12-year experience with implantable collamer lens (ICL) implantation. We reviewed 349 eyes of 216 patients, of which 155 (44.4%) were treated with spheric ICLs and 194 (55.6%) with toric ICLs.2 The mean follow-up was 47 ± 31 months (range: 3 to 127 months); however, the study included more than 40 cases with more than a decade follow-up. The preoperative spherical equivalent was -11.60 ± 5.12 diopters (D) compared with -16.90 ± 4.26 D in Moya et al.’s study. Our postoperative spherical equivalent was slightly better, -0.52 ± 1.03 versus -0.89 ± 1.26 D, perhaps due to a lower preoperative sphere, inclusion of hyperopic cases, and the use of toric ICLs. In our study, the preoperative uncorrected distance visual acuity was 1.72 ± 0.49 (20/1000 Snellen), which improved to 0.23 ± 0.22 (20/33 Snellen) (P < .001). The mean corrected distance visual acuity was 0.21 ± 0.17 (20/32 Snellen) preoperatively and 0.12 ± 0.138 (20/26 Snellen) postoperatively (P < .001). Moya et al.’s study had several strengths, such as the well-documented endothelial cell density of 2,586.61 ± 320.14 cells/mm2 preoperatively, 2,434.13 ± 290.12 cells/mm2 at 1-year follow-up, and 2,071.13 ± 361.84 cells/mm2 at the last visit, with a mean loss of 515.48 cells/mm2 (19.75%) in 12 years, which is similar to other studies with shorter follow-up.3,4 One of the strengths of our study was long-term vault measurements with anterior segment optical coherence tomography, a more objective method. The vault measurement at the last visit was 481 ± 185 μm2 in our study2 versus 444 ± 204 μm at 1 day and 242 ± 157 μm 12 years postoperatively.1 Postoperative complications were similar in both studies. We reported a total complication rate of 3.72% (13 eyes), 2% of which were ICL related and 1.72% related to myopia or other ocular pathologies,2 whereas Moya et al.’s study had 6.24% vitreoretinal-related complications. Interestingly, we did not observe any clinically relevant lens opacities, whereas Moya et al. reported 13.88% (20 eyes) with significant lens opacities and treated 7.63% (11 eyes) with bilensectomy.1 This specific complication correlated significantly (chi-square test, P = .007)1 to the V3 ICL model. Our ICL-related complications included a small vault (< 100 μm), which required an ICL exchange, two eyes had toric ICL rotation, and one case had recurrent uveitis that resolved with medical treatment. Other complications not related to the ICL included blunt trauma with related macular hemorrhage and ICL subluxation, myopic choroidal neovascularization, blunt trauma with endothelial failure treated with Descemet’s stripping automated endothelial keratoplasty,5 and a rhegmatogenous retinal detachment after ICL implantation treated with a scleral buckle. The only two severe complications in our study included a patient who underwent ICL removal due to an unresponsive toxic anterior segment syndrome and one patient with endophthalmitis who lost 2 lines of corrected distance visual acuity after intravitreal therapy and vitrectomy. Overall, our aim is to complement Moya et al.’s outstanding study with our findings in a large sample with long-term follow-up of ICL and toric ICL implantation, including visual, refractive, and anatomical outcomes and postoperative complications.