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First Author: J.Kim SOUTH KOREA
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To investigate the effect of the rotating Scheimpflug imaging system (Pentacam®; Oculus, Wetzlar, Germany) method in estimating the white-to-white horizontal diameter for Visian Implantable Collamer Lens(ICL) length determination to obtain optimal ICL vault and to evaluate the effect of vault on visual outcomes .
319 eyes of 172 patients who underwent ICL implantation were retrospectively reviewed.
Patients were divided into four groups (A1,A2,B1,B2). In 140 eyes(2.8 mm?anterior chamber depth(ACD)<3.5mm,groupA1), ICL length was determined using the conventional method(by caliper), in 123 eyes(2.8 mm?ACD<3.5mm,groupA2), ICL length was determined using the rotating Scheimpflug imaging system(rSIS) method. In 34 eyes(ACD?3.5mm,groupB1), ICL length was determined using the conventional method, in 22 eyes (ACD?3.5mm,groupB2), ICL length was determined using rSIS method. The rotating Scheimpflug imaging system(rSIS) method is a way to calculate the white-to-white distance by measuring the distance between both white edges of wedge shape in cornea stroma after the gamma correction and slope filter at cross-sectional image in the direction of 3 to 9 o"clock. The ICL vaults were measured using slit-lamp microscopy(magnification of 10x) at 30 days postoperatively. Ideal ICL vault was defined as vault between 0.8 and 1.2 corneal thickness(CT). Vault and visual outcomes were compared between each set of groups.
The mean postoperative vault was 1.12ḟ0.38 (SD) CT in groupA1, 0.96ḟ0.31 CT groupA2, 1.21ḟ0.33 CT in groupB1 and 1.15ḟ0.31 CT in groupB2 at 30 days. In rSIS method group(A2,B2), ICL vault was within the ideal range in 104(84.5%) eyes and 17(77.2%) eyes , whereas in the conventional method group(A1,B1), 87(62.1%)eyes and 20(58.8%) eyes showed ideal vault at 30 days postoperatively. Implantable Collamer Lens(ICL) length determined by rSIS method achieved significantly more ideal ICL vault than that by the conventional method (P=.011). However, the differences between the four groups were not statistically significant in terms of visual outcomes and three eyes with excessive vault(?2.5CT) was found in only the conventional method group.
To expectation the proper ICL vault, accurate estimation of white-to-white horizontal diameter is crucial. In estimating the white-to-white horizontal diameter, our novel method showed more ideal ICL vault results when compared to that of the conventional method. Hence, the rotating Scheimpflug imaging system(rSIS) method is superior to the conventional method in terms of predicting the white-to-white horizontal diameter for ICL length determination.