Three-Year Outcomes of Implantable Collamer Lens Followed by Excimer Laser Enhancement (“Bioptics”) in the Treatment of High Myopic Astigmatism
Authors Jabbour S, Bower KS
Received 25 September 2020
Accepted for publication 18 January 2021
Published 16 February 2021 Volume 2021:15 Pages 635—643
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Dr Scott Fraser
Samir Jabbour, Kraig S Bower
The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Correspondence: Samir Jabbour
The Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
Tel +1 410 583-2843
Purpose: Describe three-year outcomes of spherical implantable Collamer lens (ICL) followed by excimer laser enhancement (bioptics) in eyes with high myopic astigmatism.
Patients and Methods: Retrospective case series of thirty-four cases that underwent bioptics enhancement at the Johns Hopkins Wilmer Eye Institute. All eyes had a preoperative sphere of − 6.00 D or more with a cylinder of at least 2.00 D. Uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest spherical equivalent refraction (MSE), ICL vault measurements and central corneal thickness (CCT) were collected. Endothelial cell counts (ECC), root mean square (RMS) of higher order aberrations (HOAs), adverse events and subsequent surgeries were also assessed.
Results: All patients had a minimum follow-up of 3 years. Preoperative UDVA was 2.29 ± 0.46 logMAR and improved to 0.03 ± 0.23 logMAR at 3 years (p< 0.05). MSE was − 12.30 ± 4.05 preoperatively and changed to − 0.21 ± 0.46 at 3 years (p< 0.05). The efficacy and safety indices were 1.28 ± 0.32 and 1.47 ± 0.27 at 3 years post-enhancement. HOA did not significantly change throughout the follow-up (p< 0.05). Endothelial cell loss at 12 months was calculated at 5.7%. Two eyes required ICL exchange due to vault-related issues.
Conclusion: Bioptics offered excellent long-term safe, predictable, and efficient outcomes for high myopic astigmatism and can be considered an option if toric ICL is not available. Results confirm that wavefront-guided photoablation remains an excellent option to manage residual refractive error after phakic IOL.
Keywords: bioptics, implantable collamer lens, enhancement, excimer laser
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