Al Somali Abdulaziz Ismail
Department of Ophthalmology, King Faisal University, Al-Ahsa, Saudi Arabia.
Med Hypothesis Discov Innov Ophthalmol. 2024 Oct 14;13(3):112-120. doi: 10.51329/mehdiophthal1502. eCollection 2024 Fall.
Astigmatism is the most prevalent refractive error among children and adults, and it can lead to visual impairment if left uncorrected. The management of compound hyperopic astigmatism is more challenging. This study presents the 12-month outcomes of toric implantable collamer lens (ICL) implantation in eyes with hyperopic astigmatism.
This interventional case series included patients with simple or compound hyperopic astigmatism who underwent toric ICL implantation. All eligible individuals underwent a detailed ocular examination. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), intraocular pressure, and manifest and cycloplegic refraction results were documented. Pentacam corneal tomography was performed to assess the central corneal thickness, iridocorneal angle width, and anterior chamber depth. Endothelioscopy was performed to determine endothelial cell density. The ICL V4b model was implanted in all the included eyes. Safety and efficacy indices were calculated as postoperative CDVA/preoperative CDVA and postoperative UDVA/preoperative CDVA, respectively.
Twenty-six eyes with low-grade simple or compound hyperopic astigmatism were included. All eyes experienced a significant improvement of four lines in postoperative UDVA ( < 0.001), and their postoperative CDVA remained stable at the 12-month follow-up ( > 0.05). The safety and efficacy indices were 1.0. None of the eyes lost two or more lines of CDVA; in 81% of the eyes, CDVA was unchanged, and the proportion of eyes with 20/30 or better postoperative UDVA was identical to that with 20/30 or better preoperative CDVA (81% for each). The mean manifest spherical equivalent at the 12-month postoperative visit had significantly improved ( < 0.001). The percentages of eyes with postoperative spherical equivalent within ± 0.50 D and ± 1.00 D were 81% and 96%, respectively. The postoperative refractive cylinder improved significantly ( < 0.05), and the percentage of eyes with refractive cylinder within ± 0.50 DC and ± 1.00 DC were 50% and 77%, respectively.
Our outcomes indicate that toric ICL implantation is safe and effective for managing low-grade simple or compound hyperopic astigmatism. The proportion of eyes with 20/30 or better postoperative UDVA was identical to that with a 20/30 or better preoperative CDVA. The manifest spherical equivalent and refractive cylinder were significantly reduced. No serious safety concerns were observed. Further prospective large-scale studies with a wide range of ages and grades of hyperopic astigmatism are required to verify these preliminary outcomes.
散光在儿童和成人中是最常见的屈光不正，如果不加以矫正可导致视力损害。复合远视散光的治疗更具挑战性。本研究介绍了有远视散光的眼睛植入散光型可植入式胶原晶状体（ICL）的12个月结果。
本干预性病例系列包括接受散光型ICL植入术的单纯或复合远视散光患者。所有符合条件的个体均接受了详细的眼部检查。记录未矫正和矫正远视力（分别为UDVA和CDVA）、眼压以及显验光和睫状肌麻痹验光结果。进行Pentacam角膜地形图检查以评估中央角膜厚度、虹膜角膜角宽度和前房深度。进行内皮镜检查以确定内皮细胞密度。所有纳入的眼睛均植入ICL V4b型号。安全性和有效性指标分别计算为术后CDVA/术前CDVA和术后UDVA/术前CDVA。
纳入了26只患有低度单纯或复合远视散光的眼睛。所有眼睛术后UDVA均显著提高了四行（P<0.001），且在12个月随访时其术后CDVA保持稳定（P>0.05）。安全性和有效性指标均为1.0。没有眼睛的CDVA下降两行或更多行；81%的眼睛CDVA未变，术后UDVA为20/30或更好的眼睛比例与术前CDVA为20/30或更好的眼睛比例相同（均为81%）。术后12个月随访时的平均显验光球镜等效度有显著改善（P<0.001）。术后球镜等效度在±0.50 D和±1.00 D范围内的眼睛百分比分别为81%和96%。术后屈光柱镜有显著改善（P<0.05），屈光柱镜在±0.50 DC和±1.00 DC范围内的眼睛百分比分别为50%和77%。
我们的结果表明，散光型ICL植入术治疗低度单纯或复合远视散光是安全有效的。术后UDVA为20/30或更好的眼睛比例与术前CDVA为20/30或更好的眼睛比例相同。显验光球镜等效度和屈光柱镜显著降低。未观察到严重的安全问题。需要进一步开展涵盖广泛年龄和远视散光程度的前瞻性大规模研究来验证这些初步结果。
