Different Outcomes After Icl Implantation With Identical Vault Profiles: A Comparative Case Observation
Published 2026 - 44th Congress of the ESCRS
Reference: POREF038 | Type: Case Report | DOI: 10.82333/x6xr-2754
Authors: Dr Vera Sá Araújo* 1 , Dr Rui Silva 1 , Dr Christophe Pinto 1 , Dr José Carlos Mendes 1 , Dr Nuno Franqueira 1 , A/Prof. Tiago Monteiro 2
1Ophthalmology,Unidade Local de Saúde de Braga,Braga,Portugal, 2Ophthalmology,Unidade Local de Saúde de São João,Porto,Portugal
Purpose
To describe two patients with identical anterior segment characteristics and ICL models who both showed zero vault after one year but different lenticular outcomes.
Setting
Unidade Local de Braga, Braga, Portugal
Report of case
Case 1: A 46-year-old woman with stable myopia (-5.50/-1.50×60 OD, -6.00/-1.75×100 OS) and anterior chamber depths of 2.99 mm (OD) and 3.09 mm (OS), with white-to-white measurements of 11.39 mm (OD) and 11.58 mm (OS), underwent bilateral implantation of a 12.6 mm ICL. The postoperative course was uneventful. At 1-year follow-up, anterior segment OCT revealed a zero vault with direct ICL–lens contact; however, the crystalline lens remained completely transparent, and uncorrected visual acuity was 10/10 in both eyes. No additional anterior segment abnormalities were noted.
Case 2: A 48-year-old man with comparable biometric parameters (anterior chamber depth 3.00 mm OD, 2.96 mm OS; white-to-white 11.8 mm OD, 11.7 mm OS) underwent bilateral implantation of the same 12.6 mm ICL. At one year, anterior segment OCT similarly showed zero vault in both eyes. Slit-lamp examination revealed early anterior subcapsular cataract formation beneath the ICL contact area in the left eye, associated with a mild decrease in best-corrected visual acuity to 7/10. The right eye remained stable. Due to progressive visual compromise, ICL removal was performed in the affected eye, followed by implantation of a larger 13.2 mm ICL.
Conclusion/Take home message
The most likely explanation is multifactorial individual susceptibility. Although zero vault places both patients at high risk of direct ICL–lens contact, a recognized mechanism for anterior subcapsular opacification, contact alone is not always sufficient to induce cataract formation. Subtle individual differences in lens epithelial cell biology, age, lens thickness and position, ciliary body anatomy, intraoperative microtrauma, postoperative inflammation, and capsule resilience may modulate the response to chronic mechanical stress. These factors help explain why, despite identical anterior chamber characteristics, opacification developed in only one patient.