One-Stage Versus Two-Stage Bilateral Implantable Collamer Lens Implantation: A Comparison Of Efficacy And Safety.

Published 2023 - 41st Congress of the ESCRS

Reference: PO1003 | Type: Free paper | DOI: 10.82333/pxxz-ws85

Authors: Anna Lorger* ¹ , Martin Dirisamer ¹ , Nikolaus Luft ¹ , Siegfried Priglinger ¹ , Wolfgang Mayer ¹

¹Augenklinik LMU,Munich,Germany

Purpose

To compare the outcomes of one-stage versus two-stage bilateral implantable collamer lens implantation (ICL) for myopia and myopic astigmatism.

Setting

Eyes were subdivided in two groups to compare one-stage same-day surgery versus two-stage surgery at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were analyzed. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was -7.9 ± 2.6 diopters (D) in the one-stage and -8.0 ± 1.7 D in the two-stage group (p=0.63).

Methods

The database of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Eyes were subdivided in two groups to compare one-stage same-day surgery versus two-stage surgery at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOD) and ICL vaulting.

Results

There was no difference in the efficacy (1.1 vs. 1.2, p=0.06) and the safety index (1.2 vs. 1.2, p=0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p>0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p=0.65; 99 vs. 99%, p>0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (

90 degrees: 381.0 ± 214.1 µm vs. 270.3 ± 148.4 µm, p=0.0001; 180 degrees: 373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p=0.00007).

There were no serious intraoperative complications in either group.

Conclusions

This study demonstrates that both methods, either one-stage simultaneous

same-day ICL implantation or two-stage delayed ICL implantation are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential bene fit.