1. Anterior Segment OCT Angle and Vault Analysis After Implantable Collamer Lens  Implantation in Patients With High Myopia
Arturo Ramirez-Miranda M.D.
Alejandro Navas M.D., M.Sc.
Arturo Gómez-Bastar M.D.
Enrique O. Graue-Hernandez M.D., M.Sc.
Department of Cornea and Refractive Surgery
Instituto de Oftalmologia
“Fundacion Conde de Valenciana”
Mexico City, Mexico
Dr. Ramirez-Miranda and Dr. Navas are consultants for Carl Zeiss Meditec.
Dr. Ramirez-Miranda is a speaker of Thea Laboratoires.
The remaining authors have no financial or proprietary interest in the materials presented herein.

2. PURPOSE
To compare angle measurements before and after ICL V4c Implantation and vault changes during progress and under different light conditions, in patients with high myopia.
The purpose of this study was to compare angle measurements before and after ICL V4c Implantation and vault changes during progress and under different light conditions, in patients with high myopia, using the Visante Optical coherence tomography.
Visante optical coherence tomography (OCT SA/ Carl Zeiss Meditec)

3. METHODS Prospective, longitudinal, case series. Implantation of ICL4c.
High myopia.
75 eyes (52 patients).
AS-OCT VISANTE
(photopic, mesopic and escotopic light conditions)

4. METHODS Main Outcome Measures
Uncorrected visual acuity (UCVA)
Best corrected visual acuity (BCVA)
Slit lamp examination
Optical coherence tomography (OCT)
Angle and Vault were evaluated using an OCT Visante.

5. Preoperative Angle (°) Postoperative Angle (°)
RESULTS
75 eyes, 52 patients
32 females (69.5 %)
Follow-up 13 +/- 3 months
Mean age /- 4.8 years
Light Conditions
Preoperative Angle (°)
Postoperative Angle (°)
Angle Change(°) p
Mesopic
54.2
37.7
-16.5
<0.05
Photopic
53.5
34.6
-18.6
Escotopic
58.4
39.7
-18.7

6. RESULTS

7. RESULTS Posible eliminacion
La del astigmatismo refractivo no por que no diferencio si son toricos o esfericos
La del seguimiento por que son

8. RESULTS Posible eliminacion
La del astigmatismo refractivo no por que no diferencio si son toricos o esfericos
La del seguimiento por que son

9. Achieved Vault (microns)
Light conditions
Preoperative ACD
Postoperative ACD p
Mesopic
3.26
3.24
p>0.05
Photopic
3.22
2.85
p<0.05
Escotopic
2.90
. The mean White-to-white distance measured using OCT-Visante was / mm and Sulcus-to-Sulcus diameter was /- 0.5 mm.
Light conditions
Postoperative Angle
Achieved Vault (microns)
Mesopic
37.7
552
Photopic
34.6
507
Escotopic
39.7
374

10. DISCUSSION
ICL V4c implantation is secure, stable, predictible and effective for correction of high myopia in a 6 month follow up.
Greater influence on the vault: ICL size, the anterior chamber depth and a positive correlation with the keratometric mean power
Nevertheless, we have to consider the risk of complications including cataract, endotelial cell lost, pigment dispersion syndrome, pigmentary glaucoma and pupillary block.
The ideal achieved vault is recommended to be equal or greater than 1.0 to 1.5 mm.
Previous studies demonstrated that the ICL V4c vault is comparable with ICL previous models.
Schmidinger et al
Minimum of 230 microns for long term safety
Cronologic dinamic changes in vault and during accomodation,
Vault of at least 500 microns to avoid complications in a 25 year period.
Dong-Hoon et al determined that the most important factor to estimate the vault is the difference between the ICL and the sulcus-to-sulcus diameter
Kamiya et al observed that the achieved vault diminished 10 mm aproximately per year of age.
Greater influence on the vault: ICL size, the anterior chamber depth and a positive correlation with the keratometric mean power.

11. DISCUSSION
Few studies report the changes presented in iridocorneal angle and vault after ICL V4 implantation measured by OCT-SA Visante and during its follow up.
There are no studies that analyzed these changes with ICL V4c model.

12. CONCLUSION
ICL V4c is a secure, efficient, predictable and stable procedure.
There is a significant reduction in the iridocorneal angle after implantation.
Inverse relationship between the iridocorneal angle and the achieved vault, accentuated under different light conditions.