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Anterior Segment Implantable Contact Lenses
Table 1: Comparison of Laser-assisted In Situ Keratomileusis and
Hyperopic Correction
Implantable Collamer Lens
For hyperopia correction, Horáková et al. compared 37 LASIK eyes of 20
patients with an average age of 36.3±11.8 years and followed up for
Implantable Collamer Laser-assisted In Situ
28.1±10.2 months with 21 ICL eyes of 13 patients with an average age of
Lens (ICL) Keratomileusis (LASIK)
28.6±6.1 years and followed up for 30.4±20.9 months. Better UCVA was
Cornea Untouched Modified shape and
biomechanics
obtained with the ICL, and BSCVA improved only after ICL implantation.
Tear film Untouched Decreased (dry eye)
Post-operative refraction stability was also better with the ICL, while
Crystalline lens ICL vaulting over Untouched continuous regression was evident in the LASIK group.
20
The same authors
the crystalline lens
also demonstrated higher efficiency and safety after ICL implantation
Visual recovery Fast Delayed (flap and
during the entire follow-up period, and higher subjective patient
corneal healing
satisfaction was determined, using a questionnaire, in the ICL group.
21
HOA Low Induced HOA
CSF pressure Unchanged or Decreased
increased
Astigmatic Correction
IOL calculation for cataract Unchanged Less predictable outcome
For astigmatic correction, Schallhorn et al. performed a prospective,
Retinal image magnification Increased Less increase compared randomised study consisting of 43 eyes implanted with the toric ICL and
with ICL 45 eyes receiving photorefractive keratectomy (PRK) with mitomycin C
Effective optical zone 16–25% gain Limited for same amount
to correct myopia from -6.00 to -20.00D with astigmatism from 1.00 to
of myopia
4.00D. The toric lens performed better than PRK in all measures of safety,
Predictability Statistically more Less predictable (healing
efficacy, predictability and stability in this study. Mean BSCVA, change
predictable of tissue)
Stability Significantly better Regression and less stability
in BSCVA, proportion of cases with improvement of one or more lines of
BSCVA, proportion of cases with BSCVA and UCVA of 20/12.5 or better
CSF = cerebrospinal fluid; HOA = hypertrophic osteoarthropathy; IOL = intraocular lens.
and of 20/16 or better and predictability within ±1.00D were all
-0.92±0.69D. This group was also divided into two subgroups: for 25 significantly better in the toric IOL group at all time periods studied post-
eyes, the target was emmetropia; for the other 11 eyes, residual myopia operatively (one day, one week, and one, three, six and 12 months).
was the target. Three years after surgery in the emmetropia group, the Similarly, photopic and mesopic contrast sensitivity was significantly
average post-operative spherical equivalent was -0.99D, with reduction better at all post-operative time-points with the toric ICL.
22
of myopia by 92.0% with LASIK. The corresponding values for the ICL
group were -0.52D and 96.1%. In the group with residual myopia as the Summary
target, the average post-operative spherical equivalent was -1.74D, with Over the last decade, the ICL has undergone various stages of innovation
reduction of myopia by 86% with LASIK. The corresponding values for and development, surgical techniques have significantly improved and
the ICL group were -1.58D and 90.7%. Regarding final post-operative more information has become available on the long-term results of these
BSCVA, 1.7, 17.1, 55.7 and 22.9% of the LASIK eyes lost two Snellen techniques. Available clinical studies comparing the ICL with
lines, lost one line, were unchanged or improved by one line, respectively. keratorefractive procedures for the correction of different refractive
The corresponding values for the ICL eyes were 0, 0, 2 and 72.3%. errors demonstrate the advantages of the ICL in practically all measures
Re-operation was necessary in 17.1% of the LASIK eyes, and in 2.7% of of safety, efficacy, predictability and stability. The excellent predictability
the ICL eyes.
19
and efficacy combined with the low incidence of post-operative
complications and overwhelming patient satisfaction make the ICL and
Table 1 summarises the main differences between ICL implantation and the toric ICL extremely valuable tools for refractive surgeons to address
LASIK for the correction of myopia. the needs of their patients. ■
1. Applegate RA, Howland HC, Refractive surgery, optical 9. Sanders DR, Doney K, Poco M; ICL in Treatment of Myopia of a posterior chamber phakic IOL in one eye and LASIK in
aberrations, and visual performance, J Refract Surg, (ITM) Study Group, United States Food and Drug the fellow eye of the same patient, J Refract Surg,
1997;13:295–9. Administration clinical trial of The Implantable Collamer Lens 2007;23:935–7.
2. Oliver KM, Hemenger RP, Corbett MC, et al., Corneal optical (ICL) for moderate to high myopia; three-year follow up, 17. Lipner M, Visian ICL edges up on LASIK for high myopes,
aberrations induced by photorefractive keratectomy, J Refract Ophthalmology, 2004;111:1683–92. EyeWorld, 9 October 2007.
Surg, 1997;13:246–54. 10. Pesando PM, Ghiringhello MP, Tagliavacche P, Posterior 18. Bowers LA, ICLs correct high myopia better than all-laser
3. Durrie DS, Lesher MP, Cavanaugh TB, Classification of chamber collamer phakic intraocular lens for myopia and LASIK, Modern Medicine, 1 February 2008.
variable clinical response after photorefractive keratectomy hyperopia, J Refract Surg, 1999;15:415–23. 19. Hrubá H, Vlková E, Horácková M, Svacinová J, Comparison of
for myopia, J Refract Surg, 1995;11:341–7. 11. Sanders DR, Schneider D, Martin R, et al., Toric implantable clinical results between LASIK method and ICL implantation
4. Colin J, Robinet A, Clear lensectomy and implantation of a Collamer lens for moderate high myopic astigmatism, in high myopia, Cesk Slov Oftalmol, 2004;60:180–91.
lower-power posterior chamber intraocular lens for correction Ophthalmology, 2007;114:54–61. 20. Horáková M, Vlková E, Loukotová V, Hlinomazová Z,
of high myopia, Ophthalmology, 1997;104:73–8. 12. Sanders DR, Sarver EJ, Standardized analyses of correction of Comparison of the two methods, LASIK and ICL in mild and
5. Goldberg MF, Clear lens extraction for axial myopia, astigmatism with the Visian toric phakic implantable high hyperopia correction. Part one, Cesk Slov Oftalmol,
Ophthalmology, 1987;94:571–82. Collamer lens, J Refract Surg, 2007;23:649–60. 2007;63:143–53.
6. El-Danasoury A, Posterior chamber implantable Collamer lens 13. Sanders D, Vukich JA, Comparison of implantable contact 21. Horáková M, Vlková E, Loukotová V, Hlinomazová Z,
ICL & toric ICL. In: Agarwal A (ed.), Refractive Surgery, lens (ICL) and laser-assisted in situ leratomileusis (LASIK) for Comparison of the efficiency and safety of the two methods,
Lippincott Inc., in press low myopia, Cornea, 2006;25:1139–46. LASIK and ICL in mild and high hyperopia correction. Part
7. Zaldivar R, Davidorf JM, Oscherow S, Posterior chamber 14. Sanders DR, Matched population comparison of the Visian two, Cesk Slov Oftalmol, 2007;63:154–64.
phakic intraocular lens for myopia of -8 to -19 diopters, implantable Collamer lens and standard LASIK for myopia of 22. Schallhorn S, Tanzer D, Sanders DR, Sanders ML, Randomized
J Refract Surg, 1998;14:294–305. -3.00 to -7.88 diopters, J Refract Surg, 2007;23:537–53. prospective comparison of Visian toric implantable Collamer
8. The Implantable Contact Lens in Treatment of Myopia (ITM) 15. Sanders DR, Vukich JA, Comparison of implantable contact lens and conventional photorefractive keratectomy for
Study Group, U.S. Food and Drug Administration clinical trial lens and laser assisted in situ keratomileusis for moderate to moderate to high myopic astigmatism, J Refract Surg,
of the implantable contact lens for moderate to high myopia, high myopia, Cornea, 2003;22:324–31. 2007;23:853–67.
Ophthalmology, 2003;110:255–66. 16. Tsiklis NS, Kymionis GD, Karp CL, et al., Nine-year follow-up
74 EUROPEAN OPHTHALMIC REVIEW
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