Vertical Versus Horizontal Evo Icl Implantation: Impact On Vault, Centration, And Refractive Outcomes
Published 2026 - 44th Congress of the ESCRS
Reference: POREF118 | Type: Free paper | DOI: 10.82333/2ww0-9f15
Authors: Dr Lucia Cabrillo Estevez* 1 , Dr Ernesto Alonso Juárez 1 , Mr Pablo Villarejo Vicente 2 , Mrs Celia Paunero Peña 2
1Ophthalmology,INSADOF,Salamanca,Spain, 2Optometry,INSADOF,Salamanca,Spain
Purpose
To compare efficacy, safety, predictability, vault behavior, and postoperative centration between horizontal (H) and vertical (V) EVO ICL implantation, and to evaluate whether vertical orientation may function as an intermediate sizing strategy.
Setting
Retrospective comparative study in one single clinical site
Methods
296 eyes included(195H-101V). Eyes implanted between 2019 and 2025 with EVO phakic ICLs of power less than −10.00D were included. Minimum follow-up:1month, and one eye per patient was analyzed. Refractive outcomes, efficacy/safety indexes, predictability, vault, and intraocular pressure(IOP) were assessed. Sizing was determined using an institutional nomogram based.
Centration was evaluated using Pentacam retroillumination images by measuring displacement from the aquaport center to the corneal vertex. The decentration vector was decomposed into Cartesian coordinates. Laterality normalization was applied for combined-eye analysis. Group comparisons performed using Wilcoxon rank-sum test and exploratory variance analysis.
Results
Groups were comparable in baseline preoperative characteristics.
No significant differences were observed in refractive outcomes at 1month:UDVA 1.16±0.22(H) vs 1.16±0.22(V). SEQ −0.04±0.16D(H) vs −0.06±0.17D(V). Efficacy indexes:1.15±0.21(H)-1.15±0.22(V). Safety indexes:1.18±0.19(H)-1.19±0.19(V).
V group vault (382.9±187.2µm) was lower than H group(451.4±190.7µm), but without clinical relevance. Same with IOP: not clinically relevant.
In centration analysis, mean decentration magnitude was0.50±0.20mm(H) and 0.45±0.26mm(V). Horizontal deviation was lower in Vgroup (difference -0.12 mm; variance ratio=0.72; p=0.051). A small difference was observed in the Ycoordinate (p=0.023), despite of limited clinical magnitude.
Conclusions
Vertical EVO ICL implantation provides refractive outcomes, efficacy, and safety comparable to horizontal implantation. However, it is associated with lower and more controlled postoperative vault, consistent with a functional half-size effect.
Vertical implantation demonstrated a pattern consistent with an “intermediate size effect,” particularly in eyes with high or low cristaline lens rise.
Mean centration was similar in both orientations, although vertical implantation showed a trend toward reduced horizontal variability.
Vertical orientation may be considered a strategic tool to optimize lens sizing without compromising visual outcomes or safety.