ICL V4c With Paired Opposite Clear Corneal Incisions For Correction Of Compound Myopic Astigmatism

Purpose: To evaluate the efficacy of implantable collamer lens(ICL)V4c(with a hole)with paired opposite clear corneal incisions for correction of compound myopic astigmatism.Methods: This prospective study comprised 40 eyes of 20 patients(male,9;female,11)aged 22.5 years ± 4.5(SD)(range 18 to 28 years)who underwent implantation of the posterior phakic ICL for correction of myopia with astigmatism between May 2015 and March 2016 and 40 eyes of 20 healthy emmetropic subjects(male,10;female,10)aged24.8 years ± 3.6(SD)(range 20 to 33 years)as control group for optical quality.The inclusion criteria for the surgery were as follows: topographic corneal astigmatism ? 1.50D;stable refraction,unsatisfactory correction with spectacles or contact lenses;-6.0 to-18.0 D of myopia;anterior chamber depth ? 2.8 mm;endothelial cell density ?2000cells/mm2;no history of ocular surgery;no history of corneal degeneration,cataract,glaucoma or uveitis.Paired self-sealing opposite clear corneal incisions were made on the steep axis,one for implantation of ICL V4 c and the other for astigmatic correction.Uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BSCVA),manifest refraction spherical equivalent(MRSE),keratometry,ciliary body cysts,ocular higher-order aberrations(including total aberrations,spherical-like aberrations,coma-like aberrations and trefoil aberrations),modulation transfer function(MTF),and Quality of Life Impact of Refractive Correction(QIRC)scoring were recorded.Results: At 3 months after ICL surgery,mean postoperative logarithm of the minimum angle of resolution(Log MAR)UCVA(-0.05 ± 0.08),Log MAR BSCVA(-0.07 ± 0.06)was significantly better than mean preoperative Log MAR UCVA(1.26 ± 0.28),Log MAR BSCVA(-0.01 ± 0.09),significant differences were foud respectively(t ? 4.55,P<0.001).The vaulting was 506.9±179.9 um(range,250 to 880 um)at 3 months after ICL surgery.The IOP decreased from preoperative 14.8 ± 2.3 mm Hg(range,11 to 21 mm Hg)to postoperative 13.9 ± 2.8 mm Hg(range,8 to 19 mm Hg)(t=1.78,P>0.05).The manifest refraction spherical equivalent decreased from-10.00 ± 3.17 D(range,-4.00 to-15.75 D)preoperatively to-0.24 ± 0.30 D(range,-0.75 to 0.25 D)after ICL surgery.In the ICL group,the mean corneal astigmatism was 2.32 ± 0.59 D(range,1.60 to 3.67 D)and 1.19± 0.57 D(range,0.10 to 2.70 D)before and after ICL implantation,respectively.Mean surgically induced astigmatism by Jaffe's vector analysis was 1.35 ± 0.35 D.For 3-mm and 5-mm pupils,no significant differences was found in total higher order aberrations,spherical,coma between ICL eyes and emmetropic eyes(P ?0.13),except trefoil at 5-mm pupil.The MTF was similar between the two groups at 5 to 30 cycles per degree with 3mm and 5 mm pupils.The QIRC scores were significantly higher postoperatively(39.57± 2.18 vs.52.14 ± 1.21;P<0.001).The overall levels of satisfaction were high;95% of the patients were satisfied or very satisfied with the surgical results,and there was no dissatisfaction.Thirteen patients(65%)reported worsening night vision,mostly glare and halo in the early postoperative,which were alleviated at 1 to 3 months following the questionnaire completion.Among all the myopic patients,22 eyes(55%)presented cysts.The cysts were ? 0.5 mm in nine eyes(40.9%)and ? 1.0 mm in two eyes(9.09%).There was a characteristic distribution pattern,with cysts found predominantly in the inferior(72.7%)and temporal(77.3%)sectors.Conclusion: ICL V4 c with paired opposite clear corneal incisions is effective in correcting myopia with astigmatism and has little effect on optical quality.And it is viable to keep away from large cysts in patients with combined ciliary body cysts.