Performance Of Anterior Segment Oct–Based Formulas For Implantable Collamer Lens Sizing In Eyes Requiring Vault-Related Lens Exchange
Published 2026 - 44th Congress of the ESCRS
Reference: FP19.09 | Type: Free paper | DOI: 10.82333/acac-ec68
Authors: Dr Nicole Mechleb* 1 , Dr Pierre Zéboulon 1 , Dr Tobias Duncker 2 , Dr Raphael Neuhann 3 , Dr Bader Khayat 4 , Dr Wassim Ghazal 1 , Dr Guillaume Debellemanière 1 , A/Prof. Damien Gatinel 1 , Dr Alain Saad 1
1Rothschild Foundation,Paris,France, 2Institute of Ophthalmology,Halle,Germany, 3Eye clinic, Marienplatz,Munich,Germany, 4Suedblick Eye Clinics, ,Augsburg-Munich,Germany
Purpose
To evaluate the performance of four anterior segment optical coherence tomography (AS-OCT)–based Implantable Collamer Lens (ICL) sizing methods in eyes requiring ICL exchange for vault-related indications, and to assess whether these methods could have prevented secondary surgery.
Setting
This multicenter retrospective study included eyes that underwent ICL exchange for inadequate postoperative vault at four European centers between September 2023 and November 2025: Rothschild Foundation Hospital (Paris, France), the Institute for Ophthalmology Halle (Halle, Germany), Suedblick Eye Clinics (Augsburg-Munich, Germany), and Eye Day Clinic Marienplatz (Munich, Germany)
Methods
Primary ICL sizing was performed using the manufacturer’s nomogram. Preoperative swept-source AS-OCT imaging was retrospectively analyzed using four sizing methods: SafeVault, Nakamura–Kojima version 3 (NK-v3), KIM, and EPB formulas. Agreement between the initially implanted, exchanged, and formula-predicted ICL sizes was assessed using weighted Cohen’s kappa coefficients. Predicted and achieved postoperative vaults were compared using Friedman tests.
Results
Fourty-tthree eyes of 31 patients were included. Mean postoperative vault after primary surgery was 790 ± 515 µm, with 27.9% of eyes <250 µm and 65.1% >750 µm. SafeVault showed excellent agreement with the final implanted ICL size (κ = 0.82), whereas KIM (κ = 0.41), NK-v3 (κ = 0.47), and EPB (κ = 0.42) demonstrated only moderate agreement. SafeVault proposed a more suitable ICL size in 83.9% of cases and recommended a less suitable size in 1 case (2.4%). No significant differences were observed between predicted and achieved postoperative vaults for selected ICL sizes.
Conclusions
In eyes undergoing ICL exchange for vault-related indications, AS-OCT–based sizing methods demonstrated variable levels of agreement with clinically selected lens size. Within this context, the SafeVault approach showed consistent concordance with final surgical decisions and may provide complementary information for ICL sizing, particularly in eyes with complex anterior segment anatomy.