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Офтальмология
Khalidjan Makhamadjanovich Kamilov
Professor Tashkent Institute of
Postgraduate Medical Education
Shahida Mubashirovna Dadamukhamedova
Chief scientific staff
Republican Specialized Center of Eye Microsurgery
Nozim Nadirkhodjayevich Zaynutdinov
Independent scientific researcher,
NAZAR Eye Center, Tashkent, Uzbekistan
COMPARATIVE SHORT TERM STUDY OF POSTERIOR CHAMBER PHAKIC
INTRAOCULAR LENSES FOR THE CORRECTION OF HIGH MYOPIA. (ICL VS IPCL)
For
citation:
Khalidjan
Makhamadjanovich
KAMILOV,
Shahida
Mubashirovna
DADAMUKHAMEDOVA, Nozim Nadirkhodjayevich ZAYNUTDINOV COMPARATIVE
SHORT TERM STUDY OF POSTERIOR CHAMBER PHAKIC INTRAOCULAR LENSES FOR
THE CORRECTION OF HIGH MYOPIA. (ICL VS IPCL)
.
Journal of Biomedicine and Practice.
2021, vol. 6, issue 1, pp.118-125
http://dx.doi.org/10.26739/2181-9300-2021-1-17
ANNOTATION
To evaluate early clinical outcomes of implantation of posterior chamber pIOLs for correction of
patients with high myopia during 6 months post-op period. This study is based on comparative study
of first clinical experience to correct high myopia with implantation of EVO+ Visian ICL
(implantable collamer lens) and Implantable phakic contact lens IPCL to patients in Uzbekistan.
Key words:
High myopia; posterior chamber phakic intraocular lens, implantable collamer lens,
implantable phakic contact lens, visual acuity, vault, intraocular pressure.
Халиджан Махамаджанович КАМИЛОВ
профессор Ташкентский институт усовершенствования врачей
Шахида Мубашировна ДАДАМУХАМЕДОВА
К.м.н., старший научный сотрудник
Республиканский специализированный центр микрохирургии глаза
Нозим Надирходжаевич ЗАЙНУТДИНОВ
Независимый научный соискатель,
глазной центр “NAZAR” Ташкент, Узбекистан
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СРАВНИТЕЛЬНОЕ КРАТКОСРОЧНОЕ ИССЛЕДОВАНИЕ ЗАДНЕ - КАМЕРНЫХ
ФАКИЧНЫХ ИНТРАОКУЛЯРНЫХ ЛИНЗ ДЛЯ КОРРЕКЦИИ ПАЦИЕНТОВ С
ВЫСОКОЙ МИОПИЕЙ (ICL ПРОТИВ IPCL)
АННОТАЦИЯ
Оценить ранние клинические результаты имплантации задней камерной факичных
интраокулярных линз для коррекции пациентов с высокой миопией в течение 6 месяцев после
операции. Данное исследование основано сравнительном исследовании на первом
клиническом опыте коррекции высокой миопии с имплантацией EVO+ Visian ICL
(имплантируемая колламерная линза) и IPCL (имплантируемая факичная контактная линза)
пациентам в Узбекистане.
Ключевые слова:
Миопия высокой степени, факичная задне - камерная интраокулярная
линза, имплантируемая колламерная линза, имплантируемая факичная контактная линза,
острота зрения, пространство между линзами (vault), внутриглазное давление.
Халиджан Махамаджанович КАМИЛОВ
Профессор, Тошкент врачлар малакасини ошириш институти
Шaхида Мубашировна ДАДАМУХАМЕДОВА
Т.ф.н., катта илмий ходим
Республика ихтисослаштирилган кӯз микрожаррохлик маркази
Нозим Надирходжаевич ЗАЙНУТДИНОВ
“NAZAR” кӯз маркази, мустақил тадқиқотчи
Тошкент, Ўзбекистон
ЮҚОРИ ДАРАЖАЛИ МИОПИЯСИ МАВЖУД БЎЛГАН БЕМОРЛАРНИ
КОРРЕКЦИЯЛАШ МАҚСАДИДА ОРҚА КАМЕРА ФАКИК КӮЗ ИЧИ «ICL ВА IPCL»
ЛИНЗАЛАРИ ИМПЛАНТАЦИЯСИ АМАЛИЁТИНИНГ ҚИСҚА МУДДАТЛИ
КЛИНИК НАТИЖАЛАРИНИ ТАҚҚОСЛАМА ТАДҚИҚОТИ
АННОТАЦИЯ
Операциядан кейин 6 ой мобайнида юқори даражали миопияга эга беморларни коррекциялаш
мақсадида орқа камера факик кӯз ичи линзаларининг имплантациясини эрта клиник
натижаларини баҳолаш. Мазкур тадқиқот Ўзбекистондаги беморларга EVO+ Visian ICL ва
IPCL орқа камера факик кӯз ичи линзаларининг имплантацияси ёрдамида юқори даражали
миопияни коррекциялашнинг қисқа муддатли клиник натижаларининг солиштирма
тадқиқотига асослангандир.
Калит сўзлар:
Юқори даражали миопия, орқа камера факик кўз ичи линзаси, колламер асосли
имплантацияланувчи линза, имплантацияланувчи факик контакт линза, кӯрув ӯткирлиги,
линзалар орасидаги бӯшлиқ (vault), кӯз ичи босими.
Introduction
Phakic intraocular lenses (pIOL) for the treatment of myopia, approved by the US FDA (United
States Food and Drug Administration) in September 2004
1
, work by diverging light rays so that the
image of a viewed object is brought into focus onto the retina rather than in front of the retina. They
can be placed either in the anterior chamber (in front of the iris) or in the posterior chamber (between
the iris and the natural lens).
2
A number of studies indicate that high myopia is the fourth to seventh disease accounting for
blindness,
3-4
surgical correction of refractive errors such as high myopia includes keratorefractive
surgery, refractive lens extraction and phakic intraocular lens (pIOL) implantation. Phakic intraocular
lenses are classified as anterior chamber (AC pIOL) and posterior chamber (PC pIOL). Anterior
chamber pIOls are further subdivided based on the method of fixation to the ocular structures: angle
fixated or iris fixated. They have commonly been used to treat high myopia because they can correct
higher refractive errors than corneal refractive procedures.
5-6
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Initially, implantable lens consisting of a biocompatible collagen copolymer was developed by
STAAR Surgical, (Monrovia CA, USA) in 1993 as a sulcus-placed posterior chamber pIOL and was
called ICL. This lens can correct high refractive errors. ICL implantation has several advantages,
including faster recovery, more stable refraction, and better visual quality, reversibility of the surgical
procedure and exchangeability of the pIOL. This lens made of 60% poly-hydroxyethylmethacrylate
– HEMA, water (36%), benzophenone (3.8%) and 0.2% porcine collagen and called it the Collamer
(collagen-copolymer). Lovisolo et al 2005; Rosen et al, 1998.
7
In 2016, last modifications of EVO + Visian ICL (VICM5 model, fig 1.) for correction of
spherical refraction errors were designed and manufactured. These lenses have advanced optic size
from 4.9 to 6.1 mm, which allows to decrease night light complaints such as halos and glare, on
patients who underwent ICL implantation.
8,15
In 2013, another alternative posterior chamber pIOL was designed and manufactured by Care
Group (Vadadora, India). This lens is made of reinforced hybrid hydrophilic acrylic co-polymer
material with medium water content. It is called IPCL (implantable phakic contact lens) (V2 model,
fig 2.) with central port and has optical size from 4.25 to 5.5 mm.
9,14
In this study, we aimed to evaluate the comparative sides of two pIOLs in short clinical 6
months post-op period, after implantation of ICL and IPCL to local patients with high myopia. Such
kind of studies and investigations had never been in Uzbekistan until today.
Figure 1. ICL (VICM5 model)
Figure 2. IPCL (V2 model)
Materials and methods
This study comprised 38 eyes of 20 patients with high myopia who underwent implantation of
ICL (VICM5) and IPCL (V2) models from May 2018 to November 2020 at NAZAR Eye Center,
Tashkent, Uzbekistan. Those patients in whom LASIK surgery was contraindicated because of thin
cornea and range of myopia was higher than – 6.5 diopters (D) or more. All patients had stable
refractions within ± 0.5 D for 1 year before surgery. Each patient had undergone specialized
ophthalmic examination such as; bio ophthalmoscopy with dilated pupil by using standard 90 D
aspheric lens (Volk Inc. USA), A & B ultrasound scanning of eye globe, non-contact tonopachymetry
(Topcon, Japan), autorefkeratometry (Topcon, Japan), keratotopography (ORBSCAN III,
ZYWAVE
3
, Germany), anterior and posterior segment OCT (HD - Cirrus 4000, Zeiss, Germany).
IOL power calculation performed based on cycloplegic refraction, keratometry, axial length, anterior
chamber depth (ACD) and lens thickness. Depends on keratopachymetric and ACD results we gave
attention to anterior chamber depth from endothelium to the anterior surface of clear natural lens.
This measure could not be less than 2.80 mm. Patients with peripheral retinal tears and lesions were
treated by green laser coagulator (Novus spectra, Lumenis, USA). Exclusion criteria included lens
opacities, peripheral retinal detachments, history of uviets, glaucoma, shallow anterior chamber,
corneal pathology etc. Informed and written consents were obtained in each case. In all cases
intraocular pressure measurements and gonioscopy had been done to ensure wide open angles, best
spectacle – corrected visual acuity (BSCVA) and uncorrected visual acuity were recorded
preoperatively and postoperatively. The White-to-White (WTW) diameter was measured using a
digital biometric ruler-digital calipers. The ICL power was calculated by using the STAAR Surgical
OCOS system (Online calculation and order system) https://evo-ocos.staarag.ch/Live/. The IPCL
power was calculated by using this official web link http://www.ipcliol.com/calc/. Each eye had been
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examined by using anterior segment optic coherent tomography to determine (the vault) distance
between pIOL and anterior surface of clear natural lens in postoperative period 1,3 and 6 months.
Surgical technique
On the day of surgery, the patients were administered dilating and cycloplegic agents. Pupillary
dilation was achieved using combination of Sol. Mydoptic (phenylephrine) 2.5% and tropicamide 1%
eye drops, administered three times at 15 minutes interval, 1 hour prior to surgery. All surgeries
performed under topical and subtennon anesthesia by a single high experienced surgeon using a
standardized technique. Two clear corneal 1 mm paracentesis were made, and injected into AC
hydroxypropylmethyl cellulose 1 % - viscoelastic device. Models of pIOL (VICM5 and V2) were
implanted through a 2.8 mm temporal clear corneal incision by using a special injector and cartridge.
The pIOLs were placed and positioned into the posterior chamber by using Vukich manipulator. The
viscoelastic device was completely washed out of the anterior chamber with balanced salt solution,
and myotic agent was instilled. All surgeries were happy ended and no intraoperative complication
was observed. After surgery, combined agent (antibiotic + steroid) Sol. Tobradex 5ml 4 times a day
and Sol. Timolol 0.5% - 5ml eye drops twice a day were administered topically during 2 weeks, then
the dose of medications being reduced gradually.
Results
A total of 38 eyes of 20 patients (18 bilateral and 2 unilateral pIOL implanted patients) were
recruited in this study. All patients had undergone pIOL (VICM5 and V2 models) implantation in an
eye center by one surgeon. Preoperative demographic data are listed in Table 1. All eyes had
successful surgery and there were no intraoperative complications encountered. The mean follow –
up period was 6.1±1.5 months.
Table 1.
Preoperative both group patient demographic data and pIOL characteristics (n= 38
eyes)
Characteristic
Mean ± SD (range)
ICL (VICM5) implanted group
(n = 18)
IPCL (V2)
implanted group
(n = 20)
Age (years)
24.56 ± 4.5 (21 to 45)
23.8 ± 3.7 (21 to 45)
Gender (male:female)
4:6 (10 patients)
3:7 (10 patients)
Manifest spherical equivalent (D)
- 11.50 ± 2.75 (- 6.5 to 15.00)
- 10.25 ± 2.50 (- 7.0 to 15.00)
Manifest cylinder (D)
-0.75 ± 0.25 (- 0.50 to - 1.5)
-1.00 ± 0.50 (- 0.50 to - 1.5)
UCVA by Snellen
0.08 ± 0.05 (0.03 to 0.15)
0.06 ± 0.05 (0.03 to 0.15)
BCVA by Snellen
0.70 ± 0.15 (0.45 to 0.85)
0.65 ± 0.15 (0.50 to 0.85)
Horizontal white-to-white distance
(mm)
11.4 ± 0.6 (10.7 to 12.4)
11.6 ± 0.8 (10.8 to 12.5)
Anterior chamber depth (mm)
3.15 ± 0.25 (2.90 to 3.5)
3.15 ± 0.25 (2.90 to 3.45)
Axial length (mm)
27.34 ± 1.75 (25.75 to 29.3)
27.12 ± 1.50 (25.75 to 28.9)
Central corneal thickness (μm)
486.1 ± 25.4 (456 to 525)
492.1 ± 32.5 (456 to 530)
Keratometric readings (D)
43.4 ± 1.7 (40.2 to 48.1 )
43.6 ± 1.8 (40.5 to 47.2 )
Intraocular pressure (mmHg)
16.0 ± 2.2 (13 to 19)
16.0 ± 2.4 (12 to 20)
Implanted pIOL Power (D)
- 11.0 ± 2.5 (- 6.50 to – 15.00)
- 10.5 ± 2.75 (- 7.00 to – 15.00)
Implanted pIOL size (mm)
12.7 ± 0.75 (12.1 to 13.7)
13.0 ± 0.5 (12.6 to 13.7)
UCVA, uncorrected visual acuity. BCVA, best corrected visual acuity. SD, standart deviation.
As shown in Table 1. The mean age of patients was 24.56±4.5 in ICL group and 23.8 ± 3.7 in
IPCL group. Gender proportion was 4:6, male 40% and female 60% in ICL group. In IPCL group
was 3:7, male 30% and 70 % female. The mean SE was - 11.50±2.75 D, UCVA and BCVA by Snellen
were 0.08±0.05, 0.70 ± 0.15 in ICL group. In IPCL group the mean SE was - 10.25 ± 2.50 D, UCVA
and BCVA by Snellen were 0.06±0.05, 0.65 ± 0.15 respectively.
The horizontal white-to-white distances were 11.4±0.6 mm in ICL group and 11.6±0.8 mm in
IPCL group. The mean anterior chamber depth was 3.15±0.25 mm in both groups respectively, and
keratometric readings were 43.4±1.7 D in ICL group and 43.6±1.8 D in IPCL group. The mean axial
length was 27.34±1.75 mm and, central corneal thickness was 486.1±25.4 μm, and IOP was 16.0 ±
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2.2 mmHg in ICL group. The mean axial length was 27.12±1.5 mm and, central corneal thickness
was 492.1±32.5 μm, and IOP was 16.0 ± 2.4 mmHg in IPCL group. The mean implanted pIOL power
was - 11.0±2.5 D, and size was 12.7±0.75 mm in ICL group. In IPCL group, the mean implanted
pIOL power was - 10.5±2.75 D, and size was 13.0±0.5 mm respectively. In both groups, the mean
standard deviation has no significant difference. (p=0.05).
Patients had been observed postoperatively at the 1
st
week, 1,3 and 6 months periodically.
Postoperative examinations included UCVA, BCVA, manifest refraction, IOP measures and central
vault volume (distance between the pIOL and anterior surface of crystalline) and postoperative ICL
group patient follow–up results are shown in Table 2.
Table 2. Postoperative ICL group patient demographic data: 6 months follow – up period. (Mean
±SD)
Characteristic
Postoperative follow-up periods:
the 1
st
week
the 1
st
months
the 3
rd
months
the 6
th
months
Manifest spherical equivalent (D)
- 0.5 ± 0.75
- 0.5 ± 1.0
- 0.75 ± 0.75
- 0.75 ± 1.0
UCVA by Snellen
0.65 ± 0.05
0.70 ± 0.05
0.73 ± 0.05
0.75 ± 0.05
BCVA by Snellen
0.80 ± 0.05
0.89 ± 0.05
0.90 ± 0.05
0.92 ± 0.05
Intraocular pressure (mmHg)
15.4 ± 1.6
15.2 ± 1.4
14.8 ± 1.4
15.1 ± 2.1
Vault (μm)
420 ± 225
395 ± 232
405 ± 220
390 ± 245
UCVA, uncorrected visual acuity. BCVA, best corrected visual acuity. SD, standard deviation.
The mean remained manifest (SE) was - 0.5±0.75 D, - 0.5±1.0 D, - 0.75±0.75 D, and - 0.75±1.0
D, 1 day, 1 week and 1,3 and 6 months after surgery, respectively. The manifest SE was significantly
decreased from - 11.50±2.75 D preoperatively to - 0.5±1.0 D postoperatively. (p<0.01, Student test).
UCVA by Snellen was 0.65±0.05, 0.70±0.05, 0.73±0.05, 0.75±0.05, and BCVA by Snellen was
0.78±0.05, 0.89±0.05, 0.90±0.05, 0.92±0.05 in 1 week, and 1, 3 and 6 months after surgery,
respectively. The average UCVA and BCVA were 0.71±0.05 and 0.88±0.05. The remained manifest
spherical equivalent (SE) correction in one week, 1, 3 and 6 months after surgery 95% of eyes were
within ± 0.75 and ± 1.0 D, respectively, of the attempted SE correction. The IOP was 15.4±1.6,
15.2±1.4, 14.8±1.4, and 15.1±2.1 mmHg at 1 week, 1,3 and 6 months after surgery, respectively. The
mean postop IOP was 15.1±1.6 mmHg.
We found a significant difference between preoperative UCVA and BCVA, with 6–month
postoperative UCVA and BCVA (p = 0.05, Student test). 13 eyes (72.2%) showed BCVA by Snellen
was 0.85, 4 eyes (22.2%) had gained one line and 1 eye (5.6%) gained 2 lines more during 6 months
postoperative follow-up period.
The mean vault was 420±225, 395±232, 405±220 and 390±245 μm, and changes from minimal
to maximal measures postoperatively; 195 to 645, 163 to 627, 185 to 625 and 145 to 635 μm at 1
week, 1,3 and 6 months after surgery, respectively. In all cases, we revealed the minimal mean vault
172 μm and the maximal mean vault 633 μm. The mean average vault in ICL group was 402.5±230.5
μm. These measures showed no significant changes between 1 week and 1,3 and 6 months results.
Table 3. Postoperative IPCL group patient demographic data: 6 months follow – up period. (Mean
±SD)
Characteristic
Postoperative follow-up periods:
the 1
st
week
the 1
st
months
the 3
rd
months
the 6
th
months
Manifest spherical equivalent (D) - 0.75 ± 1.25
- 0.75 ± 1.5
- 1.0 ± 0.5
- 1.25 ± 0.5
UCVA by Snellen
0.65 ± 0.05
0.70 ± 0.05
0.73 ± 0.05
0.75 ± 0.05
BCVA by Snellen
0.75 ± 0.05
0.85 ± 0.05
0.90 ± 0.05
0.90 ± 0.05
Intraocular pressure (mmHg)
15.6 ± 1.3
15.1 ± 1.4
14.9 ± 1.5
15.1 ± 2.0
Vault (μm)
435 ± 245
415 ± 212
410 ± 232
395 ± 225
UCVA, uncorrected visual acuity. BCVA, best corrected visual acuity. SD, standard deviation.
Postoperative IPCL group patient follow–up results are shown in Table 3. IPCL group includes
20 eyes and followed up during 6 months. The mean remained manifest (SE) was - 0.75±1.25 D, -
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0.75±1.5 D, - 1.0±0.5 D, and - 1.25±0.5 D, 1 day, 1 week and 1,3 and 6 months after surgery,
respectively. The manifest SE was significantly decreased from - 10.25±2.5 D preoperatively to -
0.75±1.0 D postoperatively. (p<0.01, Student test). UCVA by Snellen was 0.65±0.05, 0.70±0.05,
0.73±0.05, 0.75±0.05, and BCVA by Snellen was 0.75±0.05, 0.85±0.05, 0.90±0.05, 0.90±0.05 in 1
week, and 1, 3 and 6 months after surgery, respectively. The average UCVA and BCVA were
0.71±0.05 and 0.85±0.05. The remained manifest spherical equivalent (SE) correction in one week,
1, 3 and 6 months after surgery 95% of eyes were within ± 0.75 and ± 1.0 D, respectively, of the
attempted SE correction. The IOP was 15.6±1.3, 15.1±1.4, 14.9±1.5, and 15.1±2.0 mmHg at 1 week,
1,3 and 6 months after surgery, respectively. The mean postop IOP was 15.17±1.5 mmHg.
We found a significant difference between preoperative UCVA and BCVA, with 6–month
postoperative UCVA and BCVA (p = 0.05, Student test). 14 eyes (70%) showed BCVA by Snellen
was 0.85, 4 eyes (20%) had gained one line and 1 eye (5%) gained 2 lines more but 1 eye (5%) had
lost one line during 6 months postoperative follow-up period.
The mean vault was 435±245, 415±212, 410±232 and 395±225 μm, and changes from minimal
to maximal measures postoperatively; 190 to 680, 203 to 627, 185 to 625 and 170 to 620 μm at 1
week, 1,3 and 6 months after surgery, respectively. In all cases, we revealed the minimal mean vault
170 μm and the maximal mean vault 680 μm. The mean average vault in IPCL group was
413.75±228.5 μm. These measures showed no significant changes between 1 week and 1,3 and 6
months results.
In early, the 1
st
day of post-up period had revealed high intraocular pressure in 1 (2.63%) eyes
(from total 38 eyes). IOP was increased up to 24 mmHg. Immediately we prescribed eye drops Sol.
Timolol 0.5% - 5 ml, twice a day for 1 week. Increased IOP slowly went down until 18.00 mmHg
during 1 week, respectively. Any secondary glaucoma case was revealed during observation period.
There were no intraoperative complications but while implanting we should re-implanted 1
(2.63%) eyes pIOL again into AC through main clear corneal temporal incision. Because while
injecting pIOL was reversed its position and optic side was touched to anterior surface of crystalline.
In these cases, we got the pIOL back gently and carefully re inject. At the end of this procedure, pIOL
was in right position. At last, this case was finished with satisfied visual result.
Discussion
Phakic intraocular lens (pIOL) implantation is so far the only refractive treatment for high
myopia that offers preservation of accommodation and potential reversibility. V. Bandary et al.
10
In our study, we found that both the types of pIOL (VICM5 and V2) in all measures of safety,
efficacy, predictability and stability showed a satisfactory visual outcome in patients with high
myopia which was maintained during 6 months follow-up period. However, we could not find much
more previous comparative studies in reviewed literature, about a significant difference between the
two-pIOL models in terms of final visual acuity gain, IOP spikes or cataract formation. Therefore,
we try to find any significant differences after implantation of both pIOls.
Concerning the safety and efficacy of the procedure pIOL implantation was safe and efficacy
for the correction of high myopia, a finding that was in line with previous studies.
1-10
we found no
significant rise of IOP and none of eyes had visually significant cataract during 6 months of post-op
follow-up period. Many studies on ICL implantation had been done till today but the first study of
ICL model with central flow technology (V4c model with central hole) performed by Shimizu et al
11
in 20 myopic eyes in 2012 (mean SE – 7.36±2.13 D) reported 95% and 100% of eyes being within
±0.50D and ±1.00 D, respectively, of the target correction. Igarashi et al. reported that ICL
implantation increases contrast sensitivity for the correction of high myopia.
12
Yan et al. reported in
2018 UCVA and BCVA post-op results 0.84±0.28 and 1.00±0.27 by Snellen, and Niu et al. in 2019
has similar visual acuity results.
13
We had the mean post-op UCVA 0.71±0.05 and BCVA 0.86±0.05 results by Snellen. Here we
can determine significant difference comparing with above-mentioned authors’ visual acuity results.
Alfonso et al. reported the mean value of IOP was 13.0±2.03 mmHg and the mean vault was
340±163 μm in studies 2019. Martinez-Plaza et al.
13
reported in their studies these values as the mean
IOP was 15.1±2.2 mmHg and the mean vault was 417.1±234.1 μm, in which has less significant
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difference with our results. Our study shows that the mean IOP is 15.4±1.55 mmHg and the mean
vault is 408.1±229.5 μm. (p<0.1).
Despite the material structure of both phakic IOL, We firstly challenged to implant those lenses
to patients with high myopia and felt any difficulties while manipulations. However, some conditions
and gently preparing technology required for ICL procedure, which depends on soft collamer
material. IPCL V2 model lens showed stronger structure, which is made of hybrid hydrophilic acrylic
material. Of course this type of pIOL more convenient on expenses and one of the alternative pIOL
to correct patients with high refractive errors in budget countries. ICL is made of collamer material,
which is unique and more biocompatibility to human eye.
In this study, we investigated first 38 eyes in which were implanted ICL (VICM5) and IPCL
(V2) pIOL models to patients with high myopia in Uzbekistan. The main privilege of this study to
compare the mean values and results after implantation of both pIOLs and follow-up in short term
period. In this study, we found any significant difference after implantation of these lenses. Patients
have satisfied results and significantly have decreased pre-op high refractive errors.
Conclusion
This study has several limitations. We hope that in future will conduct more cases with pIOL
implantation to get high statistically correlative results even any complications will acquire.
In a summary, the early outcomes of our short-term investigation showed that ICL (VICM5)
and IPCL (V2) models implantation is safe, effective and provides predictable and stable refractive
results in the correction of patients with high myopia in Uzbekistan. Expanded optic size of this ICL
(VICM5) model significantly decreases of complaints on nighttime such as halo and glare. The patient
visual performance and quality of life had increased during short post-op period. IPCL (V2) model is
one of the alternative budget way to correct these refractive errors. This procedure is safe method to
patients who has high refractive errors and requires more investigations for long follow-up period
after pIOL implantations.
References:
1.
Espandar L, Meyer JJ, Moshirfar M. Phakic intraocular lenses. Curr Opin Ophthalmology.
2008; 19(4): 349-356.
2.
Barsam A, Allan BD. Eximer laser refractive surgery versus phakic intraocular lenses for the
correction of moderate to high myopia [review]. Cochrane Database Syst Rev. 2012; 1:
CD007679.
3.
Green JS, Bear JC, Johnson GJ. The burden of genetically determined eye disease. Br. J.
Ophthalmology 1986; 70: 696 – 9.
4.
Munier A, Gunning T, Kenny D, et al. Causes of blindness in the adult population of the
Republic of Irland. Br. J. Ophthalmology 1998; 82: 630-3.
5.
Zaldivar R, Davidorf JM, Osherow S, Ricur G, Piezzi V. Combined posterior chamber phakic
intraocular lens and laser in situ keratomileusis: bioptics for extreme myopia. Journal Refractive
Surgery 1999; 15: 299 - 308.
6.
Lackner B, Pieh S, Schmidinger G, Hanselmayer G, Dejaco-Ruhswurm I, Funovics MA,
Skorpik C. Outcome after treatment of ametropia with implantable contact lenses.
Ophthalmology 2003; 110: 2153-2161.
7.
Karandikar S, Bhandari V, Reddy J. Outcomes of implantable collamer lens v4 and v4c for
correction of high myopia. Nepal Journal of Ophthalmology 2015; 7(14): 164 - 172.
8.
Kamilov Kh, Zaynutdinov N. Early clinical outcomes of implantation of posterior phakic
intraocular lens (EVO/EVO+ Visian ICL) for correction of patients with high refractive errors.
First clinical experience in Uzbekistan. Uzbek Medical Journal 2020; SI-2-11:66-74. DOI:
http:dx.doi.org/10.26739/2181-0664-2020-SI-2-11.
9.
Kamilov Kh, Kasimova M, Zaynutdinov N. New approaches of implantation of posterior
chamber phakic IOL`s to patients with high refractive errors. Point of View, East – West.
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
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125
Scientific practical journal. 2019; 4:40-46. DOI: https://doi.org/l0.25276/2410-1257-20l9-4-
40-46.
10.
Bandary V. et al.
Journal of Current Ophthalmology 2015; 27: 76-81.
11.
Shimizu K, Kamiya K, Igarashi A, et al. Early clinical outcomes of implantation of posterior
chamber phakic intraocular lens with a central hole (Hole ICL) for moderate to high myopia.
British Journal of Ophthalmology 2012; 96: 409-12.
12.
Igarashi A, Kamiya k, Shimizu K, Komatsu M. Visual performance after implantable collamer
lens implantation and wavefront-guided laser in situ kertatomileusis for high myopia. American
Journal of Ophthalmology. 2009; 148:164-170.
13.
Robert Montes-Mico et al. Posterior-chamber phakic implantable collamer lenses with a central
port: a review, Acta Ophthalmica. 2020. DOI: 10.1111/aos.14599
14.
Gitansha S, Dandapani R, Long-term safety of posterior chamber implantable phakic contact
lens for the correction of myopia. Clinical Ophthalmology 2019; 13: 137-142.
15.
Packer M. Meta-analysis and review: effectiveness, safety, and central port design of the
intraocular collamer lens. Clin Ophthalmology 2016; 1059-1077.
16.
Packer M. The implantable collamer lens with a central port: review of the literature. Clin
Ophthalmology 2018; 2427-2438.
