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Dr. Shimizu is a consultant to Staar Surgical Co. and has assisted with the development of patented technologies. No other author has a financial or proprietary interest in any material or method mentioned.

Purpose: To assess the 8-year clinical outcomes of implantation of an implantable collamer lens (ICL) with a central port (KS-Aquaport; EVO-ICL) for moderate to high myopia and myopic astigmatism.Methods: This retrospective study comprised a total of 177 eyes of 106 patients with spherical equivalents of −7.99 ± 3.33 D [mean ± standard deviation], who underwent EVO-ICL implantation. We evaluated the safety, efficacy, predictability, stability, and adverse events of the surgery, at 1 month, and 1, 2, 4, 6, and 8 years postoperatively.Results: The logarithm of the minimal angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were −0.07 ± 0.17 and −0.20 ± 0.09, respectively, at 8 years postoperatively. The safety and efficacy indices were 1.18 ± 0.24 and 0.89 ± 0.28, respectively. At 8 years, 83 and 93% eyes were within ± 0.5 D and ± 1.0 D of the targeted correction, respectively. Change in manifest refraction from 1 month to 8 years postoperatively was −0.13 ± 0.30 D. Three eyes (1.7%) that developed cataracts had a slight pre-existing peripheral anterior subcapsular cataract formation required simultaneous ICL extraction and cataract surgery at 2 or 3 years or ICL size change (1 size up) at 7 years postoperatively. We found that neither significant intraocular pressure (IOP) rise (including pupillary block) nor significant endothelial cell loss occurred in any case throughout the 8-year observation period.Conclusions: Current ICL implantation with central port technology offered good continuous outcomes for all measures of safety, efficacy, predictability, and stability for correcting moderate to high myopic errors over a long period, thereby suggesting its long-term viability as a surgical approach for the treatment of such eyes.

<h4>PURPOSE</h4><p>To present two patients in whom phakic toric Implantable Collamer Lenses (toric ICL, STAAR Surgical) have been effective for the correction of high myopic astigmatism with stable keratoconus. </p> <h4>METHODS</h4><p>Both patients had a history of contact lens intolerance, and refraction and corneal topography were stable for 3 to 4 years. Preoperatively, the manifest refraction was –10.00 –6.00 x 100 in case 1 and –8.00 –2.75 x 100 in case 2.</p> <h4>RESULTS</h4><p>Postoperatively, the manifest refraction was +0.50 –1.00 x 90 in case 1 and –0.25 –1.25 x 100 in case 2. Uncorrected visual acuity and best spectacle-corrected visual acuity were markedly improved after implantation in both patients. No progressive sign of keratoconus was seen during 1-year follow-up. </p> <h4>CONCLUSIONS</h4><p>Phakic toric ICL implantation may be an alternative for the correction of high myopic astigmatism in eyes with stable keratoconus. [<cite>J Refract Surg.</cite> 2008;24:840-842.]</p> <h4>ABOUT THE AUTHORS</h4> <p>From the Department of Ophthalmology, University of Kitasato School of Medicine (Kamiya, Shimizu, Ando, Fujisawa), Kanagawa, and Asato Eye Clinic (Asato), Okinawa, Japan.</p> <p>The authors have no financial or proprietary interest in the materials presented herein.</p> <p>Correspondence: Kazutaka Kamiya, MD, PhD, Dept of Ophthalmology, University of Kitasato School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555, Japan. Tel: 81 42 778 9012; Fax: 81 42 778 9920; E-mail: <a href="mailto:kamiyak-tky@umin.ac.jp">kamiyak-tky@umin.ac.jp</a></p> <p>Received: August 27, 2007</p> <p>Accepted: May 6, 2008</p> <p><b>Posted online: May 30, 2008</b></p>

This study aimed to compare the achieved vault using a manufacturer’s nomogram and the predicted vault using the currently available prediction formulas after posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens; ICL, STAAR Surgical) implantation. We included 200 eyes of 100 consecutive patients (mean age ± standard deviation, 34.3 ± 7.8 years) undergoing ICL implantation with a central hole. Three months postoperatively, we quantitatively measured the actual vault, and we compared it with the predicted vault using anterior segment optical coherence tomography (CASIA 2, Tomey). The agreement rate of the recommended ICL size using the manufacturer’s nomogram, the NK formula, and the KS formula was 50.0%. The achieved vault was 477.1 ± 263.7 µm, which was significantly smaller than the predicted vaults of 551.2 ± 335.1 and 606.4 ± 212.2 µm, using the NK and KS formulas, respectively (Dunnett test, p = 0.014, p < 0.001). The achieved vault was not significantly different from the predicted vault using the NK or KS formula (p = 0.386, p = 0.157) when selecting a 12.1 mm ICL size. It was not significantly different from the predicted vault using the NK formula (p = 0.962), but it was significantly smaller than that using the KS formula (p = 0.033) when selecting a 12.6 mm size. It was significantly smaller than the predicted vault using the NK and KS formulas (p < 0.001) when selecting 13.2 mm size. The total agreement rate of the recommended ICL size was approximately 50%. The predicted ICL vault tended to overestimate the actual ICL vault, especially when selecting a larger ICL size.