Clinical Outcomes Of Presbyopia-Correcting Ipcl Plus Implantation And Casia2-Based Crystalline Lens Rise Screening

To report clinical outcomes after presbyopia-correcting IPCL Plus implantation and to assess the plausibility of a CASIA2 crystalline lens rise (CLR) cut-off (≤500 µm) for achieving adequate postoperative vault.

Single-center study in Japan.

We analyzed 61 eyes of 32 patients (19 male, 13 female; age 50.4 ± 3.5 years) undergoing presbyopia-correcting IPCL Plus implantation. Standard visual and refractive outcomes were assessed preoperatively and postoperatively (1M, 3M, 6M, 1Y) when available. CASIA2 metrics included preoperative CLR and postoperative vault. Vault analyses used a per-eye final vault dataset (last available timepoint; n=34) stratified by CLR (<0, 0–<250, 250–≤500 µm) with exact 95% confidence intervals (Clopper–Pearson). A 6-month restricted subset was also analyzed (6M vault available; n=13).

UDVA (logMAR) improved from 0.09±0.28 (n=61) preoperatively to −0.06±0.12 at 1M (n=61) and −0.11±0.07 at 6M (n=37) (both p<0.0001). UNVA improved from 0.52±0.45 to 0.19±0.21 at 1M and 0.10±0.14 at 6M (both p<0.0001). MRSE improved from −5.14±3.19 D to −0.12±0.43 D at 1M and −0.05±0.33 D at 6M (both p<0.0001). In the per-eye final vault analysis (n=34), vault <250 µm occurred only in the 250–≤500 µm CLR stratum: 0/4 (0%; 95% CI 0–60.2%) for CLR<0, 0/11 (0%; 95% CI 0–28.5%) for 0–<250, and 4/19 (21.1%; 95% CI 6.1–45.6%) for 250–≤500; vault <200 µm was 1/19 (5.3%; 95% CI 0.1–26.0%). Mean ECD decreased from 3064±195 cells/mm² preoperatively (n=61) to 2566±275 at 1M (n=46), with a trend toward stabilization over time.

Presbyopia-correcting IPCL Plus implantation yielded favorable visual and refractive outcomes. In an exploratory CASIA2-based vault analysis, low-vault events (<250 µm) clustered in eyes with higher preoperative CLR (250–≤500 µm), supporting the clinical plausibility of a CLR screening cut-off of ≤500 µm, while emphasizing closer monitoring for eyes near the upper CLR range. Because the crystalline lens continues to thicken with age in presbyopic patients, CLR may be particularly relevant for maintaining an adequate vault after presbyopia-correcting phakic IOL implantation and for counseling patients regarding long-term safety margins.