Icl Outcomes Across Myopia Severity: Real-World Udva And Vault Using Correlated-Eye Modelling

To evaluate visual and safety outcomes of EVO+ Visian ICL implantation for myopia correction in a Latvian cohort, and to identify biometric predictors of postoperative vault. 

Single-center, single-surgeon retrospective study at a tertiary ophthalmology clinic in Riga, Latvia.

Consecutive EVO+ ICL cases for myopia ± astigmatism were retrospectively analysed (105 patients, 207 eyes; spherical and toric lenses; OCOS sizing). Primary endpoint was ΔUDVA (logMAR). Secondary endpoints: UDVA thresholds, vault categories and IOP. Inter-eye correlation was handled with patient-random-intercept mixed models (continuous outcomes) and GEE logistic regression (binary outcomes). Vault predictors were assessed using multivariable mixed models on log(vault).

Median follow-up was 12 months (IQR 4–24). Mean UDVA improved from 1.29 to −0.04 logMAR (p<0.001); 87.9% achieved UDVA ≥1.0 (95%CI 82.7–92.0%). Efficacy index was 1.05±0.20. Vault was optimal (250–750 µm) in 79.5%; 9.8% <250 µm and 10.7% >750 µm. IOP >21 mmHg in 3.4%. ICL exchange was required in 2 patients (1.9%): one for persistent high vault with elevated IOP, one for toric rotation (both bilateral). No sight-threatening complications were recorded. High myopia (SE≤−10D) reduced odds of UDVA≥1.0 (GEE OR=0.21, p=0.02). Vault was independently predicted by ICL size (p<0.001), WTW (p=0.02), and ACD (p=0.02); larger ICL and deeper ACD increased vault, wider WTW decreased it.

In this single-center Latvian real-world cohort, EVO+ ICL implantation yielded excellent functional vision, with 87.9% achieving UDVA ≥1.0 and a low rate of secondary surgical intervention (1.9%). High myopia (SE ≤−10 D) was associated with a lower likelihood of reaching UDVA ≥1.0. Postoperative vault was primarily driven by ICL size, with additional contributions from WTW and ACD, underscoring the importance of biometric-based sizing. These results confirm the safety and efficacy of EVO+ ICL.