biometric factors affecting vaulting after intraocular collamer lens implantation

Biometric Factors Affecting Vaulting After Intraocular Collamer Lens Im-

plantation.

David Sung Yong Kang1,2, Jin Young Choi1, Hun Yang1, Ik Hee Ryu1, Hee Sun Kim1,

Seong Bae Park1, Jin Kuk Kim1 and Chan Yun Kim2.1. Clean Vision Eye Center, GangNam, Seoul, Korea. 2. Yonsei University College of Medicine, Seoul,

Korea.

The Authors have No Financial Interest in the Subject Matter of this Poster.

OBJECTIVES 1. To Evaluate Pre-operative Biomet-

rics Predictive of Final ICL Vaulting.

2. To Evaluate Manufacturer Recom-mendation Lens Size on Final ICL Vault Outcome.

METHODS Retrospective Observational Non-Interventional Case Series

Duration: 2009.9 – 2010. 4 At Least 6 months F/U

Participants: 133 Eyes of 67 pts Im-planted with 120 sized V4 Intraocu-lar Collamer Lens (ICL, Starr Surgical).

METHODSPre-Op. Biometric Evaluation:

1. Corneal White-to-White(WTW): Keratograph (70600, Oculus)2. Anterior Chamber Depth (ACD) Measurement: A-Scan (SP-3000,Tomey,Japan)3. Sulcus-to-Sulcus Measurement(STS): Ultrasound Bio-Microscopy(UBM,Aviso,Quantel Medical) 4. Angle-to-Angle(ATA) Measurement, Angle Parameters (AOD, TISA 500 & 750) Anterior Segment Optical Coherence Tomography (OCT): (Visante OCT, Carl Zeiss Meditech, Dublin,CA)5. Anterior Chamber Volume Assessment: Pentacam (Oculus)

Post-Op. Biometric Evaluation: 1. ICL Vaulting2. Angle Parameters (AOD & TISA 500 & 750) All by Visante OCT.

METHODSNo. of Eyes Reason Measures POD #

Weeks2 High V Exchanged # 1 & 3 2 Low V Exchanged # 4 2 Non-Patent

PI High VFurther PI # 2 & 3

5 Steroid In-duced OHTN

Anti-HTN Medication

1 F/U LossFinal In-clusion

121

Exclusion Criteria

V: Vaulting, PI:Laser Peripheral Iridotomy, OHTN: Ocular Hypertension, F/U: Follow up

METHODS

High Vault: >750 Microns

Optimal Vault:250 – 550 Microns

Low Vault: <250 Microns

Evaluated at POD # 6 Months With Anterior Segment OCT

Low V(n=10)

P value( Low vs Op-

timal)Optimal V

(n=87)P value

( High vs Op-timal)

High V(n=24)

Total(n=121)

Age 29.70(4.55) 0.0003 24.97 (3.69)

0.42 25.67 (4.10)

Sex(M:F) 2:8 0.49 32:55 0.67 10:14AXL 26.58

(1.11)0.09 27.22

(1.15)0.30 27.52 (1.46)

ACD 3.12 (0.18) 0.004 3.31 (0.19) 0.49 3.34 (0.20)ACV 191.8

(28.35)0.03 209.7

(22.99)0.46 205.8

(20.78)WTW 11.64

(0.11)0.0003 11.85

(0.24)0.0006 11.70 (0.17)

ATA 12.18 (0.21)

0.84 12.16

(0.32)0.003 11.94 (0.23)

STS 11.61 (0.23)

0.08 11.76 (0.21)

0.009 11.63 (0.21)

AOD500 0.44 (0.16) 0.14 0.53 (0.19) 0.35 0.57 (0.17)AOD750 0.63 (0.21) 0.11 0.76 (0.24) 0.45 0.81 (0.21)TISA500 0.15 (0.05) 0.14 0.18 (0.06) 0.43 0.19 (0.06)TISA750 0.28 (0.09) 0.11 0.34 (0.12) 0.41 0.37 (0.10)

RESULTS

The t-test Procedure; SPSS Ver12.0; p<0.05 considered Siginificant

Specificities at Fixed Sensitivi-ties

Variable Sensitivity(%)

Specificity(%)

Cut-Off Value

WTW 85 37.5 11.65STS 81.4 39 11.56ATA 80.2 31.8 11.895

Optimal vs High Vaulters

Optimal vs Low VaultersVariable Sensitivity(

%)Specificity(

%)Cut-Off Value

WTW 85.1 22.2 11.65ACD 81.6 44.4 3.125ACV 80.5 30 188.5

WTW: White-to-white(mm), STS: Sulcus-to-Sulcus(mm), ATA: Angle-to-Angle(mm)

WTW: White-to-white(mm), ACD: Anterior Chamber Depth(mm), ACV: Anterior Chamber Volume(mm3)

Combination of Specificities: vs High Vaulters

WTW(>11.65)

ATA(>11.895)STS(>11.56)90%

(Sensitivity > 80%)

Frequency Proportion Analysis

88.4% 83.6%

86.7%

(WTW, STS and ATA; all in mm)

Combination of Specificities: vs Low Vaulters

WTW(>11.65)

ACV(>188.5)ACD(>3.13)93.4%

92.5% 91%

94.2%

Frequency Proportion Analysis(WTW, ACD and ACV; mm and mm3)

(Sensitivity > 80%)

VS Manufacturer Rec-ommendations

(#Manufacturer Recommendations for All ICLs that were Finally Implanted with 120 Sized S4 ICL)

Recommenda-tion#

Low Vault

Optimal Vault

High Vault

%

115 1 21 1 19.0120 9 26 14 40.5125 0 39 9 39.7130 0 1 0 0.8

CONCLUSIONS1. Age, ACD, ACV and WTW were significant factors in predicting Post-op Low Vaulters.

A Combination of these Factors Raised Predictability to 93.4%.

2. STS, ATA and WTW were Significant Factors in Predicting Post-op High Vaulters. A Combination of these Factors Raised Predictability to 90%.

3.Current Paradigm of Relying on ACD, WTW and STS may need to be Revised in Asian Eyes.

4. Manufacturer Guidelines cannot be Infallible in Predicting Ideal Vaulting, especially In Asian Eyes.