Intraoperative Optical Coherence Tomography-Guided Implantable Collamer Lens (Icl) Surgery: A Prospective Observational Study

This study aimed to evaluate the clinical utility of intraoperative optical coherence tomography (iOCT) in optimizing the implantation of posterior chamber phakic Implantable Collamer Lenses (ICL V4c).

This study aimed to evaluate the clinical utility of intraoperative optical coherence tomography (iOCT) in optimizing the implantation of posterior chamber phakic Implantable Collamer Lenses (ICL V4c).

A prospective observational series included100 eyes (50 patients) undergoing ICL surgery with real-time iOCT imaging (Zeiss Rescan 700). Key parameters assessed were vault height, lens-tissue interaction, and intraoperative adjustments prompted by iOCT findings.

iOCT provided high-resolution visualization of the ICL-crystalline lens interface, iridocorneal angle dynamics, and haptic positioning during surgery. In 2 eyes (2%), iOCT identified suboptimal vaulting (<150 µm) or haptic misalignment, prompting immediate intraoperative repositioning. Postoperative spectral-domain OCT at 3 months demonstrated stable vault heights (mean 430 ± 110 µm) with 100% of eyes achieving target refraction within ±0.5 D. Comparative analysis revealed a 20% reduction in postoperative vault-related complications compared to historical controls without iOCT guidance (p=0.02).

 Real-time iOCT enhances surgical precision in ICL implantation by enabling dynamic assessment of lens positioning and anatomical relationships, thereby reducing the need for postoperative interventions. This technology demonstrates significant potential for improving safety and refractive predictability in phakic intraocular lens surgery.