Manual White-To-White Sizing And Postoperative Vault In Evo Icl Surgery: A Consecutive Case Series

To evaluate vault outcomes and exchange rates using manual white-to-white (WTW) measurements with a modified STAAR sizing nomogram in a consecutive series of EVO ICL cases.

Clinical refractive surgery

Single-surgeon retrospective review of 68 consecutive eyes undergoing EVO ICL implantation. Sizing was determined using manual WTW measurements and anterior chamber depth (ACD) in conjunction with a modified STAAR nomogram. Postoperative vault was recorded at the earliest stable postoperative visit and final follow-up. Primary outcomes included mean vault, distribution of vault categories, and ICL exchange rate.

Mean postoperative vault was 499.8 ± 193.4 µm (range 157–1120 µm).
Seventy-five percent of eyes (n=54) demonstrated vault within 250–750 µm.
Seven eyes demonstrated vault <250 µm and six eyes >750 µm; however, no cases required ICL exchange. There were no instances of angle closure, visually significant cataract formation, or secondary surgical intervention related to vault.

Manual WTW measurements combined with a modified STAAR nomogram yielded predictable vault outcomes with zero exchange rate in this series. Despite occasional outliers, this simplified sizing approach demonstrated clinical reliability and safety. Manual WTW remains a practical strategy for ICL sizing in routine clinical practice.