Implantable Collamer Lens (ICL) Explantation and Cataract Surgery
Title: Implantable Collamer Lens (ICL) Explantation and Cataract Surgery
Author (s): Russell Swan, MD; Mark Mifflin, MD
Keywords/Main Subjects: Implantable Collamer Lens; ICL; Cataract; Anterior subcapsular cataract; Myopia
Diagnosis: Anterior subcapsular cataract; Cataract; ICL
Description of Video: This patient is a 42 year old male who presented to the ophthalmology clinic for decreased vision and symptoms of glare in his left eye after having implantable collamer lenses placed 4 years prior. On exam he was found to have 20/40 vision and a primarily anterior subcapsular cataract of that eye. He also had mild nuclear and posterior subcapsular changes. After a discussion of the risks benefits and alternatives to ICL explantation with simultaneous cataract surgery the patient elected to proceed with surgery.
This video demonstrates the surgical approach to ICL removal and also emphasizes the importance of correctly sizing the ICL at the time of implantation to reduce the risk of cataract formation.
Most studies examining the incidence of cataracts after ICL implantation report a rate between 1-5%1. It is worth noting that the most study with 8 year follow-up reports a 4.9% rate of visually significant cataract formation and an additional 10% of patients who have asymptomatic cataract formation. In addition, they reported an average 6.2% endothelial cell loss over 8 years in these patients. In this series at 8 years 68.3% of patients were within 0.5 diopters of their targeted correction and 85.4% were withing 1.0 diopter. In this series there was no significant change in intraocular pressure (IOP) over the 8 year time period.
Igarashi, A. et al. Eight-Year Follow-up of Posterior Chamber Phakic Intraocular Lens Implantation for Moderate to High Myopia. American Journal of Ophthalmology. 157.3:532-539. March 2014.
Faculty Approval by: Mark Mifflin, MD