Materials and Methods

This retrospective study evaluated the eyes of consecutive patients from January 1, 2007 to September 30, 2010 who had accidental intraoperative inversion of Visian ICL (STAAR Surgicals) for the correction of myopia. All the case files of ICL implantation from the described period were reviewed. Patients with bilateral ICL implantation with accidental intraoperative inversion of the Visian ICL followed by viscocannula-assisted reinversion in 1 eye and normal Visian ICL implantation in the fellow eye were included. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (noncontact tonometry), endothelial count (SP-2000P; Topcon, Tokyo, Japan), anterior chamber reaction (Standardization of Uveitis Nomenclature), lens transparency (assessed with serial slit-lamp lens photography), corneal topography (Orbscan; Bausch & Lomb, Rochester, New York, USA), anterior chamber depth (ACD), and slit-lamp biomicroscopy were compared at various time intervals (1 month, 6 months, 2 years) between the reinverted and the fellow eyes.

Surgical Technique

When the Visian ICL was found to have unfolded in the upside-down direction, the anterior chamber was immediately formed with dispersive viscoelastic 2% hydroxypropylmethylcellulose (Viscomet; Milmet Pharma Ltd, Baroda, India). The haptic edge of the Visian ICL was tilted from below with the tip of the viscocannula in the clockwise direction and at the same time the viscoelastic was injected behind the ICL ( Figure 1 ). This step was continued until the ICL was halfway folded. Then the viscocannula tip was placed below the lower flap of the folded ICL and the haptic was pushed up ( Figure 2 ), thereby unfolding the ICL. This placed the ICL in the correct position. Care was taken not to touch the optical center of the ICL. A surgical peripheral iridectomy (PI) was performed and the entry wound in the cornea was hydrated. All patients were on topical antibiotics and steroids in the immediate (2 weeks) postoperative period.

Viscocannula assisted reinversion. (Top left) Viscocannula is placed below the haptic edge to elevate the implantable collamer lens. (Top right) Viscoelastic is injected below the haptic. (Bottom left) Haptic is rotated in the clockwise direction. (Bottom right) The haptic is rotated until it is halfway folded.

Viscocannula assisted reinversion. (Top left, Top right, and Bottom left) Implantable collamer lens is half folded while the viscocannula touches the haptic edge to rotate in clockwise direction. (Bottom right) Implantable collamer lens centered at the end of rotation.

Results

In the retrospective analysis, a total of 206 eyes underwent Visian ICL implantation in the described period. Out of 206 eyes, 8 eyes (3.8%) of 8 patients had accidental intraoperative inversion. All 8 patients had inversion of ICL with viscocannula-assisted reinversion in 1 eye and normal ICL implantation in their fellow eyes. All 8 inversions were noted only in the early learning curve. There were 4 right (OD) and 4 left (OS) reinverted eyes. The preoperative refractive error ranged from −14 diopters (D) to −18 D in the reinverted and −14.5 D to −18 D in the fellow eyes. The mean preoperative ACD was 2.88 ± 0.08 mm and 2.89 ± 0.07 mm in the reinverted and the fellow eyes respectively. The mean white-to-white (WTW) distance was 11.3 ± 0.4 mm and 11.2 ± 0.4 mm in the reinverted and the fellow eyes respectively.

The mean postoperative UCVA and BCVA were 0.74 ± 0.21 and 0.78 ± 0.25 respectively in the reinverted eyes. There was significant improvement in the postoperative UCVA in the reinverted (Wilcoxon signed rank test P = .012) and the fellow eyes ( P = .028). There was no significant difference (Mann-Whitney U test, 1 month, 6 months, and 2 years) between the 2 groups with respect to UCVA ( P = .611) and BCVA ( P = .854).

There was no significant difference ( Table 1 ) in the pachymetry from the preoperative to the postoperative period in both groups. There was no significant difference between the preoperative and the postoperative anterior chamber depth in the reinverted eyes (Wilcoxon signed rank test P = .066). There was no significant difference between the reinverted and the fellow eyes with respect to the postoperative ACD ( P = .915). The mean preoperative cell density was 3256.4 ± 299.9 cells/mm ² and the mean cell density at 2 years postoperatively was 3169.4 ± 277.5 cells/mm ² in the reinverted eyes. The mean percentage loss at 1 month, 6 months, and 2 years was 0.96% ± 0.5%, 0.92% ± 0.63%, and 0.89% ± 0.52% respectively in the reinverted eyes. There was no significant difference ( Table 2 ) in the percentage loss of the endothelial cells between the 2 groups at 1 month ( P = .753), 6 months ( P = .834), and 2 years ( P = .916). One out of 8 eyes with reinversion had postoperative corneal edema, which spontaneously resolved at 48 hours, and on day 1 the endothelial cell count was measured as 2530 cells/mm ² . There was no significant difference between the reinverted and the fellow eyes with respect to postoperative Sim K value in Orbscan ( P = .645). None of the eyes reported postoperative uveitis or glaucoma in the 2 years of follow-up. Lens transparency was maintained in all eyes, as seen by the serial slit-lamp lens photography. The mean vault in the reinverted eyes was 0.41 mm ± 0.3 mm.

TABLE 1

Comparison of the Postoperative Changes of the Reinverted Eyes With the Fellow Eyes of Implantable Collamer Lens Implantation Over the Period of Time

	Preoperative UCVA (Decimal Equivalent)	1 Month	6 Months	24 Months	Preoperative CCT (μm)	1 Month	6 Months	24 Months	Preoperative ACD (mm)	1 Month	6 Months	24 Months
Fellow eyes	0.66	1	1	1	594	578	588	588	2.9	2.88	2.88	2.88
	1	1	1	1	588	584	588	588	2.9	2.91	2.91	2.91
	1	1	1	1	652	658	650	652	2.88	2.86	2.86	2.86
	0.16	0.33	0.33	0.33	603	756	630	606	2.9	2.9	2.9	2.9
	0.25	0.66	0.66	0.66	429	448	440	440	3	3	3	3
	0.05	0.66	0.66	0.66	559	562	560	558	3	2.9	2.9	2.9
	0.16	0.66	0.66	0.66	487	490	480	484	2.8	2.78	2.78	2.78
	0.16	1	1	1	580	500	482	442	2.8	2.8	2.8	2.8
Reinverted eyes	0.01	1	1	1	594	578	588	588	2.82	2.81	2.81	2.81
	0.01	1	1	1	588	584	588	588	2.9	2.9	2.9	2.9
	0.01	0.5	0.5	0.5	652	658	650	652	2.88	2.86	2.86	2.86
	0.01	0.66	0.66	0.66	603	756	630	606	2.9	2.9	2.9	2.9
	0.01	0.5	0.5	0.5	429	448	440	440	3	3	3	3
	0.03	1	1	1	559	562	560	558	3	2.96	2.96	2.96
	0.05	0.66	0.66	0.66	487	490	480	484	2.8	2.78	2.78	2.78
	0.1	0.66	0.66	0.66	520	512	514	498	2.8	2.8	2.8	2.8

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Repeatability and Reproducibility of Biometry and Keratometry Measurements Using a Noncontact Optical Low-Coherence Reflectometer and Keratometer
2. Significant Correlation Between Visual Acuity and Recovery of Foveal Cone Microstructures After Macular Hole Surgery
3. Autofluorescence Imaging and Spectral-Domain Optical Coherence Tomography in Incomplete Congenital Stationary Night Blindness and Comparison With Retinitis Pigmentosa
4. Reply

Stay updated, free articles. Join our Telegram channel

Join